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Contempo 1998
November 25, 1998

The Changing Managed Care–Public Health Interface

Author Affiliations

From the Office of the Dean (Dr Roper) and the Department of Health Policy and Administration (Mr Mays), School of Public Health, the University of North Carolina at Chapel Hill. Dr Roper is a member of the JAMA Editorial Board.

JAMA. 1998;280(20):1739-1740. doi:10.1001/jama.280.20.1739

MEDICAL PRACTICE and public health in the United States have remained functionally separate during most of the 20th century despite many similarities in mission and method.1 The growth of managed health care has fueled a flurry of analysis and speculation about how managed care will affect the distinctions and the interactions between these 2 fields of practice. Some policy analysts and health plan executives argue that, because managed care plans assume clinical and financial responsibility for the health of defined populations, they have both opportunities and incentives for integrating aspects of medical care and public health practice.2-5 Collaborative relationships between managed care plans and public health agencies emerge as a mechanism for sharing the human, financial, and intellectual resources required to implement public health activities.6 Other observers warn that managed care plans may weaken the public health infrastructure, in part by siphoning off patients and Medicaid revenues that traditionally have supported public health agencies and related safety-net providers.7,8 Observers also suggest that health plans, which are mostly for-profit corporations, fail to engage in many public health activities because they are not profitable over relatively short time horizons or among enrollee populations that are constantly changing.9