The managed care blues and how to cure them

American health care: yesterday, today and tomorrow: the long and winding road : The old non-system ; The logic of managed care ; Managed care under attack ; Fulfilling the promise ; Strategies for the future

1. The failure of the old insurance system: the thrill is gone : It worked for all, except ... ; No invisible hand ; The tax man subsidizeth ; Weak buyers and unique markets ; The costs of scientific advance ; Self-insurance and the first-hand experience ; Markets and trade-offs ; No contest: the government versus costs ; Controlling costs, expanding services ; The government versus providers ; Costly compromises: the birth of Medicare ; Price controls: the Nixon years ; Providers win a pyrrhic victory ; Reinventing Medicare

2. Quality in the old system: not what we thought: I've been loving you too long : Professionalism will do the job ; The cottage industry cannot adjust ; Accountability ; Practice variation ; The information explosion ; Tolerance of errors ; Too much focus on disease, not enough on health ; What role for professionalism

3. The rise of managed care: birth of the blues : Early opposition ; The 1970s and the health maintenance organization ; The rise of HMOs and the loss of physician domination ; Managed care diversifies ; New niches and new products ; Fron minority to majority status ; The trends converge ; The Clinton plan: managed care and markets emerge victorious

4. The tools of managed care: you can't always get what you want : The logic of managed care ; A taxonomy of managed care ; Managed care's tool box ; Utilization management and preauthorization ; The tools in action ; Conclusion

5. The cutting edge of quality improvement: good vibrations : Quality improvement programs and practice guidelines ; Demand management ; Programs for the catastrophically and chronically ill ; Disease management ; Specialty benefit carve-outs ; The logic of managed care meets reality.

6. The managed care backlash: stop in the name of love : Dissecting the horror story ; Consumer concerns: who comes first? ; Choice, access, and quality ; The greed factor ; The physician backlash ; Conclusion: consumers at risk

7. The managed care record: better than you think: sympathy for the devil : It costs less, and that counts ; Blame the system ; Exaggerated fears ; Too broad a brush ; Misunderstanding value ; Quality in managed care: what we know and don't know ; Consumer satisfaction ; Quality in managed care: they're both wrong

8. Rule of price; cult of choice; cost of quality: you better shop around : The components of value ; Price: the bottom line rules ; Choice: of physician, plan, and other things ; Quality: the stepchild ; Summary

9. Protecting the floor: they can't take that away from me : Consumer protection: two approaches ; Approaches to protecting the floor: some wise, some not

10. Thirteen steps to raising quality in managed care: with a little help from my friends : From employer to employee choice ; Expanding consumer choice to delivery systems, not just insurers ; Enhancing the power of the purchaser ; Toward more cost-conscious consumers ; Getting sophisticated: the subtler health care trade-offs ; Improving the ability to choose: the information revolution, part one ; Improving clinical performance: the information revolution, part two ; From opposition to leadership: the role of physicians ; Toward greater health plan liability: another approach to malpractice ; Consolidation vs. integration: an antitrust challenge ; Competing on quality: the devil in the details ; A national report on health care quality ; From traditional regulation to the bully pulpit

Epilogue: Bridge over trooubled water.