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March 12, 1997

The Managed Care Manual

Author Affiliations

Medford, NJ

JAMA. 1997;277(10):853-854. doi:10.1001/jama.1997.03540340087039

The house-dust mite, Dermatophagoides pteronyssinus. From: Color Atlas and Text of Clinical Medicine, by Charles D. Forbes and William F. Jackson, 2nd ed, 534 pp, with illus, paper, $42.95, ISBN 0-7234-2198-6, London, England, Mosby-Wolfe, St Louis, Mo, Mosby, 1997; reproduced by permission.

Managed care is payers telling physicians how to practice medicine. Whether this is bad or good depends on your point of view. In medical school we were never taught what the cost or the outcome of "standard" care was. Only since insurance companies, employers, and taxpayers have demanded that spiralling costs be controlled has the medical community come to focus on cost and outcome.

The focus has been put on the providers of care, since 85% of the costs have been generated by them. Today, unless you are in a very small and remote town and the only physician practicing there, you probably have experienced some form of