Conflicts in Managed Care

Abstract

Managed care changes traditional indemnity insurance and fee-for-service practice by integrating the financing and delivery of medical services, with the aim of controlling costs and improving quality. Both the patient and the physician are managed through policies that restrict the patient's choice of providers and medical options and that limit the clinical autonomy of doctors.Managed-care organizations use a variety of approaches to change the decisions of doctors and providers.¹ They may use case managers to coordinate medical care in expensive cases, financial incentives to encourage physicians to make medical decisions that conserve resources, gatekeepers to control referrals for specialty . . .