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To the Editor: Dr Robinson¹ argued that the era of managed care has passed. However, whether managed care is dead or alive depends on the definition of managed care. If by managed care Robinson means health maintenance organizations (HMOs), perhaps he is right. However, managed care is flourishing in many forms and there does not appear to be such a thing as "unmanaged care" remaining. Despite the bad image, polls show HMO member satisfaction is equal to that of traditional plans.²

Robinson is correct that managed care is an economic success and a political failure but it was a medical success as well. There is no evidence that quality suffered. In fact, most studies show better care under HMOs than under traditional plans.³

When employers pay a fixed amount of premium cost and allow employees to choose among several plans and costs, it widens employees' choice of physician and sharpens . . . [Full Text of this Article]

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The End of Managed Care
James C. Robinson
JAMA. 2001;285(20):2622-2628.
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