When do developing countries adopt managed care policies and technologies? Part II: Infrastructure, techniques, and reform strategies.
OBJECTIVE
To specify the essential infrastructure elements required to implement managed care techniques successfully in a developing country, once the necessary macroeconomic preconditions for managed care have been met. Also, to describe how managed care techniques can be integrated into health system reform strategies.


METHODS
Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reform in developing countries.


RESULTS
Successful managed care relationships among payers, providers, and patients rely on several essential infrastructure elements: enabling legislation; regulatory mechanisms to administratively correct health and insurance market failures; enforceable contracts; and formal groups or associations of providers. Once these infrastructure elements are in place, a developing country government can consider implementing 1 or more managed care techniques, including payment strategies, demand-side techniques, and utilization management.


CONCLUSIONS
Governments in many developing countries can take deliberate steps to accelerate the evolution of certain macroeconomic preconditions--human capital and information systems--and essential infrastructure elements necessary to support managed care techniques. They may then choose to experiment carefully with implementing specific managed care techniques, with consideration given to how the managed care techniques can promote primary care.
Luck
Jeff
J
West Los Angeles Veterans Affairs Medical Center, UCLA School of Public Health, Los Angeles, Calif, USA.
Peabody
John W
JW
D002017:Budgets; D003695:Delivery of Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D003906:Developing Countries / Q000191:economics*; D004059:Diffusion of Innovation; D006076:Government; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D018803:Models, Economic; D017149:Private Sector / Q000191:economics / Q000458:organization & administration; D017150:Public Sector / Q000191:economics / Q000458:organization & administration