livery in the United States" (Wells, Astrachan, Tischler, & Unutzer, 1995, p. 57). Managed care has two goals in particular·to control health care costs and to provide quality services that are sufficient enough to satisfy the enrollees. Several strategies based on direct control of care and indirect economic incentives are used. Payment incentives include capitation to encourage the provider to use fewer services and copayments and deductibles to discourage over-use of services by patients. Provider designation assures that physicians are selected to provide quality care at the least cost; this includes using primary care gatekeepers, limitations on specialty referral, and the monitoring of physician practice. Coverage policies limit services that will be paid. Traditional insurance mechanisms are strategies that discourage enrollment of high-risk patients, excluding coverage for preexisting conditions, and experience rating (Quickel, 1996).
Over the past 50 years, managed care programs have existed such as the Kaiser Permanente Medical Care Program (California) and the Health Insurance Plan of New York City. These programs only affected a minority of patients and physicians, until the past six or seven years during which managed care has grown significantly. Rising costs of health care, particularly in industry, and the fact that approximately 15 percent of the United States population lacks health insurance, have provided stimulus for this growth; health care expenditures account for over 14 percent of the gross domestic product in the United States. Management of medical services is attempted through managed care. It is estimated that around 100 million individuals are now covered by a managed care plan and that 77 percent of employers offer a managed care program (Friedenberg, 1996; Sunshine & Evens, 1994; Quickel, 1996).
Some people have concluded that through managed care, a universal health policy mandated by th...