by Enthoven, Fuchs & Shortell

“What inhibits the spread of managed care and managed competition across the country? One possible answer is that their principal contribution is to control costs, and the demand for cost control is not as strong as most policy experts think it should be. Most industries, including health care, want an increase in their revenue, not a decrease. But what about the public? A 2019 National Opinion Research Center General Social Survey  asked a sample of the general public (59 000 respondents) what change they wanted to see in the level of health care spending. Sixty-nine percent favored an increase and 10% favored a decrease. Paradoxically, a Gallup survey of 1000 US adults reported in April 2019 that health care costs were the most important financial issue facing families.”

“The same public that in other contexts complains about the cost of care indicate they would like an increase in spending. One possible explanation is that the 17% of respondents in the Gallup survey who named health care costs the most important problem are a narrow segment with low income, very large medical care expenses, or both. Alternatively, most of the public mistakenly perceive that overall spending can increase without higher costs for them. Media discussion of “employer-provided care” and promises from politicians about “giving people health care” contribute to this misperception.”

“When an economic or health care crisis comes, cost control will have priority, but crisis solutions are rarely the wisest. Managed care and managed competition are not panaceas. As is true of all types of medical care interventions, clinical or organizational, not every individual attempt will succeed; however, managed care and managed competition have a good record of success in controlling costs and maintaining quality without resorting to price controls, the principal alternative.”
– JAMA Published online November 7, 2019 –