title: Managed care merged with the German model.
abstract: The cutbacks in Medicare and Medicaid reimbursement, and the Republican takeover of Capitol Hill and the state legislatures as a result of recent elections, suggest that the payer-driven forces of managed care, capitated payment, and the regional networks (alliances) will serve as centerpieces to improve the organization, financing, and delivery of America's health services. These "voluntary" alliances that are now being forged as an amalgam of health providers and insurance underwriters, often foreshadow the powerful, geographically linked regional health networks that are evolving into oligopolies throughout the United States. As the Department of Justice and the Federal Trade Commission are unable to appropriately analyze the efficacy of most prospective mergers, the American health field increasingly can expect monopolistic environments. In this process, the public eventually may demand the formation of state health services commissions. Within this framework, the German decentralized, multipayer, multitier approach, which historically is self-governing and allows for negotiating reimbursement rates between insurers and providers, offers a preferred option to the traditional American public utility model.
authors.affiliation: Bedford Health Associates, Inc., Management Consultants for Health and Hospital Services, Asheville, NC 28804, USA.
authors.forename: T P
authors.initials: TP
authors.lastname: Weil
mesh_terms: D016363:Antitrust Laws; D005858:Germany; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012041:Regional Medical Programs / Q000458:organization & administration*; D013221:State Health Plans / Q000458:organization & administration; D014481:United States