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This issue of the Archives and those of all 10 American Medical Association scientific journals are devoted to articles on managed care and its impact on the practice of medicine. We have attempted to solicit and encourage submission of articles on a broad array of relevant topics from those knowledgeable in these areas and from investigators who have identified new, pertinent, and timely information. Many thoughtful and reflective clinicians, administrators, and researchers from across America have contributed to this issue. They provide their own personal and sometimes sobering views.
Managed care is not new to American medicine. The first group practice in the United States was established 110 years ago at the Mayo Clinic in] Rochester, Minn, and the first capitated plan was started 67 years ago. The constraints imposed by managed care have become a principal determinant of how primary and specialty care are delivered. Decisions about direct access