Definitions and Concepts

In this introduction, the development tendencies that aid and impede managed care will first be discussed. Subsequently a definition framework will be developed which will address the instruments and organisational forms in more detail, as well as the consequences that result. The consideration of inhibiting factors is necessary because, after a period of massive growth at the beginning of the decade, managed care is seen increasingly critically – sometimes even with hostility – and certain market segments proved to be unsustainable and have since disappeared. Despite all critique, including partly justified criticisms, there is no doubt that substantial elements have become indispensable to our healthcare systems and are now considered givens. In most cases the critique is not directed against managed care instruments (e.g. Disease Management Programmes), but rather against the behaviour of the programme participants (inappropriate exclusion from services, risk selection and/or excessive pressure on the service providers). Accordingly, managed care has a substantial image problem, at least in the United States. However, due to the obvious deficits of “unmanaged care” and increasing financial pressure to act, managed care has experienced a renaissance. A number of pilot projects have shown that higher quality and at the same time lower costs are not necessarily a contradiction. The belief that there is nothing more expensive than poor quality care is increasingly prevalent as well as vice versa, that quality care is the most affordable form of care.