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May 19, 1993

Incorporating Prevention in Managed Care

JAMA. 1993;269(19):2505. doi:10.1001/jama.1993.03500190047022

To the Editor.  —There is much interest in managed care across the United States at present.1,2 While definitions of managed care vary, many proposals include several common elements, in particular, reorganizing health services to provide more comprehensive coverage and access to care while containing cost. Several jurisdictions are organizing health system authorities that would involve contracts with primary care providers, including physicians, clinics, hospitals, health maintenance organizations, and other providers. Most managed care strategies have been conceptualized and are starting to be operationalized based on largely economic analyses.From a population perspective, managed care should seek to assure improved provision of preventive as well as curative services. This implies assuring that prevention is as valued a clinical activity as the provision of curative medical services. A major problem with the existing health care system is that there is no equity in the remuneration of practitioners engaged in disease prevention