Most proposals for the reform of the national health care system are based to some extent on the concept of managed care (Mariner, 1994, pp. 1515-1520). These managed care proposals generally are characterized by packages of defined benefits that deny individuals access to unlimited health care, and the denial of any health care service that is not deemed to be a medical necessity. Critics of the managed care approach contend that, under such a regime, patients' rights will become subservient to economic concerns, as medical necessity becomes increasingly defined within the context of costs. This researcher supports this contention.
Many managed care organizations, particularly health maintenance organizations (HMOs) generally are well rated by their members (Braus, 1994, pp. 17-18). The general relationship between managed care plans and the level of patient health, however, is a murky area (Relman, 1994, pp. 471-482). The trend in the growth in the role of for-profit managed care in the United States may be very much a part of a trend toward the development of a two-tiered system of health care services delivery in this country. Increases in the cost of health insurance is another factor in this trend. Restrictions on health care coverage for the economically disadvantaged by a parsimonious government is yet another factor. A serious implication of this situation is the potential denial of access to necessary health care services for a large segment of the population. The implementation of a managed care regime as a part of national health care reform could exacerbate the problem.
The two-tiered health care system that may evolve in the United States will be defined primarily by access to health care services. Those individuals whose employers provide supplementary health care insurance to them and their families, and those individuals with sufficient financial resources
...