The paradoxical politics of provider reempowerment.
The recent decline, indeed perhaps dismantling, of managed care is sometimes treated as both consequence and cause of the political reempowerment of medical providers, whose professional dominance managed care had challenged. Drawing evidence from Round III of the Community Tracking Study of the Center for Studying Health System Change, this article reviews the politics of four "arenas" of managed care regulation--prompt payment, mandated benefits, external appeals, and financial solvency--and concludes that the power of providers is contingent on patterns of coalition and conflict that differ across the discrete arenas. The zero-sum connotations of the "de" and "re" empowerment of providers under managed care fail to capture the subtlety of providers' search for fresh cultural, economic, and political resources in shifting policy contexts.
Brown
Lawrence D
LD
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, USA.
Eagan
Elizabeth
E
D003258:Consumer Behavior / Q000191:economics; D004465:Economic Competition; D033161:Government Regulation; D019981:Health Care Sector / Q000639:trends; D006291:Health Policy; D006801:Humans; D007342:Insurance Benefits / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D011057:Politics; D011209:Power, Psychological; D011364:Professional Practice / Q000458:organization & administration*; D014481:United States