To some extent, managed care has lived up to that promise. In 1994, for the first time in more than a decade, there was a net decrease in the amount that employers paid for their employees' health care. The decrease was due to the higher percentage of employees enrolled in managed care plans. Unfortunately, managed care has fallen short of its full potential as a means of improving patient care and creating cost savings. The reason is that true managed care is actually very hard to find in this country.
Patients enter the system through a primary care physician.
This doctor serves as a gatekeeper, regulating whether and when specialty consultation and treatment are available to them. If a referral is made, it is to a specialist who has a contract with, or is a member of, that particular organization. Prenegotiated discounts and fewer overall referrals lead to savings. After the treatments are finished, there is continuity of care as the patient continues to be followed by his or her primary care doctor. The distinction between true managed care and gatekeeper care is revealed at the referral step.