d future contexts.
Managed care is rapidly becoming the pervasive regime through which medical care is being delivered in the United States. A widespread perception holds that critical medical decision-making is passing from qualified medical professionals to cost-accountants and managers who focus on organizational bottom-lines as opposed to patient needs (Mullen, 1997). If this perception is valid, it is essential to validate it while there is time to initiate steps to reverse the trend. By contrast, if the perception is not valid, this fact must be substantiated so that health care reform in the United States can proceed in an orderly manner. This study contributes to these needs.
The scope of this study is limited to the effects that managed care has had, is having, or is likely to have on the quality of surgical care delivered to patients. There are various mechanisms through which managed care can affect surgical care, and these mechanisms are within the scope of the research performed for this study.
Literature is reviewed that is relevant to the issue of the effects of managed care on the quality of surgical care delivered to patients. Considerations of the availability of relevant literature and the organization of the literature review are addressed in the remainder of this introductory section, following which the results of the literature review are presented.
The literature dealing with the effects of managed care on surgical care and on the mechanisms through which these effects occur is extensive. As managed care is a relatively new approach to the widespread delivery of health care in the United States, however, much of this research is contradictory. Literature representative of the various views on managed care is included in this review.
Organization of the Literature Review
The findings of the literature review are presented in four major sections. The first major section, "Background," pro...