How Managed Care Is Reinventing Medicaid and Other Public Health-Care Bureaucracies

Bibliographic Data

ID10397349
AuthorsJohn Portz (0000-0003-4365-7697), John H Portz, Matthew F Reidy, Matthew Reidy, David A Rochefort (0000-0001-7004-535X)
Year1999
Volume59
Issue5
Pages400-400
Publication date1999-09-01
Open AccessNo
TypeARTICLE
VenuePublic Administration Review (JOURNAL)
Journal identifiersISSN: 0033-3352 • E-ISSN: 1540-6210
PublisherWiley (PUBLISHER • GB)
DOI10.2307/977423
OpenAlexW2016622638
LanguageEN
Citations received5
References cited5

Approximately three-quarters of U.S. workers with health insurance are enrolled in a health maintenance organization, preferred provider organization, or point-of-service health plan (Jensen et al., 1997). More than 53 percent of all Medicaid recipients, and 10 percent of Medicare recipients, also receive their health from plans (Health Care Financing Administration, 1998a,b). These workers and public program beneficiaries are participating in a fundamental and sweeping restructuring of American medicine. In general terms, managed care refers to of medical delivery in which patients' utilization of health services is controlled by organizations which may deny payment for services that are deemed medically unnecessary, are not approved by the organization, or are provided by health professionals outside the organization's network. Managed organizations typically make use of financing innovations that contain costs by reducing provider reimbursements or limiting the average expenditure per enrollee. By such means, the health marketplace is experiencing a new push for economic efficiency, market competition, and, most controversially, corporate profit taking (Gabel, 1997). The growth of has spurred a growing body of health policy research on services utilization, health costs, and patient satisfaction. Almost ignored, however, is the impact of on the public bureaucracy. In fact, is creating a host of new pressures, incentives, and responsibilities that are reshaping government departments with a stake in Medicaid and in health and mental health delivery. Administrative, policy, and political roles, as well as internal operations and external relations, are all being affected. To a significant degree, is the public health bureaucracy. As a reform movement, the idea of reinventing government has captured considerable attention among both practitioners and academics. Advocates seek nothing less than a new set of principles to guide public management. For these proponents, the traditional bureaucratic focus on inputs, processes, and rules is replaced by tenets of competition, customer choice, performance measurement, and privatization; public agencies must be more flexible and responsive to a rapidly changing environment. Osborne and Gaebler (1992) popularized the concept of reinventing government with their call for an entrepreneurial spirit to transform the public sector. Citing the virtues of a competitive market, these authors envisioned a public sector in which competition and customer choice would drive administrative reform. In short, public agencies must clarify their mission and purpose; they must operate within an environment of incentives and consequences; they must empower workers and citizens; and they must be accountable to their customers (Osborne and Plastrik, 1997). Many federal, state, and local officials have quickly become disciples of the reinventing government movement. At the level, for example, Vice President Al Gore assumed a prominent position as leader of the government's National Performance Review, launched in 1993. Gore declared that the federal government is filled with good people trapped in bad systems: budget systems, personnel systems, procurement systems, financial management systems, information systems (Gore, 1993, 2). In the same year, Congress passed the Government Performance and Results Act, emphasizing new types of performance assessment (Kettl, 1995; Radin, 1998). At the state level, reinventing government strategies are evident--including training programs to improve customer service, strategic planning and mission development, and quality improvement programs--although implementation varies widely (Brudney, Hebert, and Wright, 1999). Significantly, Public Administration Review has featured reinventing government as a symposium theme three times during recent years (PAR, 1998; PAR 1996; PAR, 1994)

Bureaucracy · Business · Health care · Managed care · Medicaid · Medicaid managed care · Political science · Politics · Healthcare innovation and challenges · Healthcare Policy and Management · Law · Medicine · Nursing · Public Administration · Public Policy and Administration Research

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