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The Private-Sector Challenge

Jonathan Showstack, MPH; Nicole Lurie, MD, MSPH; Sheila Leatherman; Elliott Fisher, MD, MPH; Thomas Inui, ScM, MD

JAMA. 1996;276(13):1071-1074.

Abstract
The rapid growth of managed care poses challenges and opportunities for the health of the public. The fundamental risk is that both mission and accountability will be defined too narrowly; the opportunity lies in broadening both. What would a socially responsible managed care system look like? Such a system would provide excellent individual care to its enrollees, yet it would also include programs and activities that address broader populations and policies. We propose 8 attributes of such a system that can be used as a guide by managed care systems and to judge whether a managed care system is a responsible, accountable, and responsive contributor to the health of its community. As the role of the public sector shrinks, the private sector must expand its responsibility. It is both prudent and reasonable for managed care systems to seize their unique opportunity to improve the health of the public.

Author Affiliations
From the Department of Medicine and Institute for Health Policy Studies, University of California, San Francisco (Mr Showstack); School of Medicine (Dr Lurie) and Institute for Health Services Research, School of Public Health (Dr Lurie and Ms Leatherman), University of Minnesota, Minneapolis; United HealthCare Corp, Minneapolis (Ms Leatherman); Departments of Medicine and Family and Community Medicine, Dartmouth Medical School, Hanover, NH, and Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, Vt (Dr Fisher); and Department of Ambulatory Care and Prevention, Harvard Medical School, and Harvard Pilgrim Health Care, Boston, Mass (Dr Inui).

Footnotes
Ms Leatherman is an officer and shareholder in United HealthCare Corp, a managed care and health maintenance organization company.

The opinions expressed in this article are those of the authors and may not represent the views of The Pew Charitable Trusts, the Robert Wood Johnson Foundation, or the Allina Foundation.

Reprints: Jonathan Showstack, MPH, Health of the Public Program, University of California, San Francisco, 735 Parnassus Ave, San Francisco, CA 94143-0994.

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