We conclude with a possible economic forecast for its future and the importance for physicians to remain closely involved with the politics of health care to help guide this revolution to a happy ending. The managed care revolution of the 1980's and 90's has resulted in a fundamental power shift from the providers to the payers of health care. To begin to understand some of the reasons that led to this remarkable change in the US health care system, it is helpful to review annual U.S. national health expenditures and to compare these expenditures with those of other countries and relate them to some of the health care outcomes produced by our system. Such a review reveals that all has not been well with U.S. health care. The last fifty years have seen dramatic health care cost increases without undisputed superiority in health care outcomes.
More money is spent on health care than on food and housing combined.
Economics lies at the root of the managed care revolution. It was a revolution waiting to happen. Managed care companies who a ssume risk and, as a business, seek to maximize profit and minimize cost. Government and business are considered organized payers, which increases their influence in the market place. Money spent on health care represents income for the health care industry i.e. its providers, suppliers and insurers, and an expense to payers.