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A Work in Progress

Paul M. Ellwood, Jr, MD; George D. Lundberg, MD

JAMA. 1996;276(13):1083-1086.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The modern JAMA has been working toward comprehensive American health system reform since 1987, emphasizing cost control, access for all, and promotion of quality.¹ One of us (P.M.E.) has been developing market-based health system thinking for more than 25 years.² The concept of managed care is hardly new. The Kaiser plans began in the American West in the 1930s.³ The massive reform that has occurred in the 1990s has been phenomenal and largely unpredicted, although much of it has been called for by many authors.^4-6 Many patients, providers, and purchasers alike consider the system to be in turmoil, some even in chaos. But movement is profound and irreversible, at least in the short run.

As we go forward, we believe that physicians should be more involved and influential in determining where the American health system is going. It is unrealistic to expect to return to unmanaged, . . . [Full Text PDF of this Article]

Footnotes
Dr Ellwood is President of The Jackson Hole Group, Teton Village, Wyo, and Dr Lundberg is Editor, JAMA. Dr Ellwood owns stock in Medical Logic, Oxford Health Plan, and Physicians Health Services.

Reprints: Paul M. Ellwood, Jr, MD, The Jackson Hole Group, PO Box 350, Teton Village, WY 83025.

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