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November 1994

Health (Care) Reform, Managed Care, and Ophthalmology

Author Affiliations

The Johns Hopkins School of Hygiene and Public Health Baltimore, Md

Arch Ophthalmol. 1994;112(11):1417-1418. doi:10.1001/archopht.1994.01090230031016

I MUST CONFESS from the start that the timing and nature of health care reform are as speculative as they are inevitable; that "managed care" has as many different stripes as "health care reform," and their balance is subject to the evolving outcome of the health care reform debate; and that all predictions are subject to change at a moment's notice.

Why health care reform in the first place? Put simply, because our present system of providing and paying for health services is inefficient, ineffective, and inequitable. As Brody et al1 noted, it "provides appropriate high-quality care to a small group, inappropriately complex care to a larger group, and virtually no care at all to far too many." It does not fulfill "Sommer's maxim"2: maximizing the quality years of life at a cost society can afford.

We spend more on health care than any other country, whether in

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