Providers and Patients Respond to Medicaid Managed Care: Ethnographic Insights from New Mexico
Medical Anthropology Quarterly Special Issue 19(1): 2005
Foreward
by Merrill Eisenberg
Managed health care became an ominous reality in the United States in the 1980s in response to precipitous increases in health care costs. As the cost of health care rose, so did the cost of private health insurance as well as publicly funded health care such as Medicaid. Government efforts in the 1970s to contain health care costs through planning and regulation had been largely coopted by weak regulatory authority and political influences, and, not surprisingly, they had failed almost universally. However, as the major purchases of health insurance policies, employers had a keen interest in containing health care costs and they recognized and utilized their power in the health insurance marketplace to create reform. The private sector was first in demanding a change in the fundamental way health care services are reimbursed. They took control over the volume of services rendered from the hands of physicians and put it into the hands of watchdogs with an eye toward restricting services and keeping costs low–private sector managed care organizations.
Managed care was first unleashed in the private sector–on America’s workers and their families. Issues around access to care, difficultues obtaining referrals for specialist care, disruptions in referral networks, and convenience for patients were apparent.
Nevertheless, in the short term, the rise in health care costs did begin to slow. The implementation of managed care in programs that serve the poor came relatively late. With the exception of Arizona (which didn’t have a Medicaid program at al until 1982 when it created the first state program using a prepaid capitated model), most states did not begin to introduce managed care into their Medicaid programs until the 1990s. In many states, the impact on the more fragile Medicaid populations and service systems was devastating. Sadly, the cost of managing care and the profits taken from the system by managed care organization investors have added to the cost of delivering health care, and costs now continue to rise.
In this special issue, guest edited by Louise Lamphere and Nancy Nelson, we see the impact of Medicaid managed care on vulnerable populations in New Mexico. Lamphere and Nelson provide us with a description and analysis that situates the change in reimbursement models and its impacts on systems, organizations, staff, and patients.
From Medical Anthropology Quarterly 19(1):1-2, 2005.
Louise Lamphere 