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Book and Media Reviews
February 8, 2006


JAMA. 2006;295(6):697-698. doi:10.1001/jama.295.6.697

In The Rise and Fall of HMOs, Jan Gregoire Coombs offers a detailed case history of a famous prepaid group practice—the Greater Marshfield Community Health Plan—set against the background of the development of the health maintenance movement (formerly a loose collection of prepaid health care organizations in a few selected areas of the United States) and its eventual metamorphosis into managed care. Coombs is not alone in considering this pilgrim's progress a revolution. As described on the Web site of the Agency for Healthcare Research and Quality (http://www.ahrq.gov/research/managed.htm), dramatic change of US medical systems is linked to a future in which managed care becomes the dominant health care delivery system. Whether that would be good or bad is an open question to many. Whether an increase in health maintenance organization (HMO) or managed care enrollment of persons younger than 65 years from roughly 7% in the early 1980s to roughly 20% in 2004 represents a dramatic or revolutionary change is a question more of perspective than numbers.