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February 24, 1997

Managed Care, Managing Uncertainty

Author Affiliations

Department of Preventive Medicine University of Tennessee College of Medicine 956 Court Ave, Room F208 Memphis; Memphis

Arch Intern Med. 1997;157(4):385-388. doi:10.1001/archinte.1997.00440250023003

THE "MANAGED care" paradigm has challenged most aspects of conventional health systems. Debate abounds on the efficacy,1 ethics,2 and finance3 of these systems. Meanwhile, enrollment in managed health systems continues to rise4 as employers urge employees to opt for lower-cost health plans and as states reform Medicaid systems to control governmental budgets.5

To understand the issues that managed care presents to the health care endeavor, it is important to understand what is managed. The implied object may be the budget, the physician, health care resources, or, more optimistically, the care of the patient. In this essay, we suggest that one object that is managed is uncertainty.

UNCERTAINTY IN MEDICAL PRACTICE  Uncertainty is a fact of life in medical practice. We, as physicians, usually do not know unequivocally the full extent of a patient's disease and even less often do we know the best single approach

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