th about managed care likely lies at some point along this continuum of opinion, it is the contention of this researcher that reasoned assumptions are not applicable to commercial organizations whose primary interests are seeking to maximize the returns on their investments, as opposed to assuring that patients receive optimal care which means that patients receive a high quality of care even if attaining that objective means sacrificing an arbitrary profit objective. The professed intent of the application of the managed care concept is to balance access to services, service quality, and the cost of services in relation to health care (Goldfield, 1994). The actual intent of the managed care concept, however, based on this researchers observation of managed care, is the development and implementation of a system that permits university-trained MBAs to make decisions on patient care that should be made by medical professionals and their patients.
Managed care is becoming the "backbone of health care delivery in the United States" (Wells, Astrachan, Tischler, & Unutzer, 1995, p. 57). Managed care, according to its proponents, has two goals in particular·to control health care costs and to provide the quality of care of services that are sufficient enough to satisfy the enrollees. A major problem with the second of these stated goals is that it is the administrators of managed care plans who decide whether the quality of care of the services provided are sufficient to satisfy enrollees.
Several strategies based on direct control of care and indirect economic incentives are used in the managed care system. Payment incentives include capitation to encourage the provider to use fewer services and copayments and deductibles to discourage over-use of services by patients. Each of these tactics is inimical to the quality of care delivered. Provider designation assures that physicians are selected to provide a quality of care that ...