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Previous Volume 338:1635-1639 May 28, 1998 Number 22

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Part 1 of this article suggested that without countervailing forces, market pressures to reduce costs in managed care may compel all health maintenance organizations (HMOs) to adopt practices that compromise medical ethics and patient care. Theoretically, there are two types of counterweights: those that rely on market discipline and those external to the market. How effective are they?

Market Discipline: The Discerning Consumer

Advocates of market discipline in health care, such as Alain Enthoven and Regina Herzlinger, propose systems in which consumers discipline health plans and providers by choosing among competing plans.^21,22 Ironically, the late Clinton health care proposal, criticized as too bureaucratic, offered consumers . . . [Full Text of this Article]

The Quality Movement

The Politics of Regulation

Commercial HMOs Strike Back

Medical Professionalism

Path Dependence

Source Information

Co-editor, The American Prospect, 6 University Rd., Cambridge, MA 02138.

References

This article has been cited by other articles:

• Chang, G., Wilcox, M. (2005). Case Study: A Medicaid Health Maintenance Organization Quality Initiative for Behavioral Health. American Journal of Medical Quality 20: 98-103 [Abstract]  
• Roetzheim, R. G., Pal, N., Tennant, C., Voti, L., Ayanian, J. Z., Schwabe, A., Krischer, J. P. (1999). Effects of Health Insurance and Race on Early Detection of Cancer. JNCI J Natl Cancer Inst 91: 1409-1415 [Abstract] [Full Text]  
• Grumbach, K., Selby, J. V., Damberg, C., Bindman, A. B., Quesenberry, C. Jr, Truman, A., Uratsu, C. (1999). Resolving the Gatekeeper Conundrum: What Patients Value in Primary Care and Referrals to Specialists. JAMA 282: 261-266 [Abstract] [Full Text]  
• Himmelstein, D. U., Woolhandler, S., Hellander, I., Wolfe, S. M. (1999). Quality of Care in Investor-Owned vs Not-for-Profit HMOs. JAMA 282: 159-163 [Abstract] [Full Text]