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Quality in managed care: promise versus reality

More than 1 million Americans will have an acute myocardial infarction this year. Although we have learned a great deal about different treatments that can reduce mortality after myocardial infarction (1) , every year thousands of patients are discharged without receiving optimal treatment (2) . The data describing these shortcomings in treatment are based primarily on patients being cared for in a traditional fee-for-service environment. Would care for these patients be better or worse if they were enrolled in managed care plans? That is the question addressed by Seddon et al (3) in this issue of The American Journal of Medicine . Previous studies comparing quality of care in managed care and fee-for-service environments have shown mixed results (4,5) . In general, simple preventive services, such as immunizations and mammograms, are delivered at higher rates in a managed care environment. Enrollees in managed care plans report less satisfaction with care, however, and experience more difficulty in accessing specialized services. Elderly, poor, and chronically ill enrollees are more likely to experience functional decline. During the past 20 years, we have seen major changes in our health care delivery system. Not only are more people enrolled in managed care plans, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Medicine Elsevier
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