Submit a paper that identifies and discusses a specific concept (such as managed care, capitation, integrated delivery systems, etc.) or landmark legislation (for example, Hill-Burton Act, creation of Medicare and Medicaid, Managed Care Act, etc.) that significantly changed the delivery of healthcare in the United States. In writing this paper, you should consider and address (as necessary) the following questions: Your paper should be 8-10 pages in length and conform to . Include at least six scholarly references from peer-reviewed articles.

Title: The Development of Managed Care in the United States: A Paradigm Shift in Healthcare Delivery


Managed care is a comprehensive healthcare delivery system that has significantly transformed the healthcare landscape in the United States. This concept emerged in the 1970s as a response to rising healthcare costs and the need for a more efficient and coordinated approach to healthcare delivery. This paper aims to explore the concept of managed care, its evolution, and its impact on the delivery of healthcare in the United States.

Definition and Evolution of Managed Care

Managed care can be defined as a system of delivering and financing healthcare that aims to control costs while providing high-quality care through various mechanisms such as utilization management, financial incentives, and coordinated care delivery (Kongstvedt, 2007).

The early roots of managed care can be traced back to the 19th century, with the development of health insurance plans such as the Blue Cross Blue Shield Association. However, it was not until the 1970s that managed care gained prominence as a response to escalating healthcare costs and the need for cost containment strategies (Popejoy, 2018).

One of the key milestones in the development of managed care was the enactment of the Health Maintenance Organization (HMO) Act of 1973. This legislation encouraged the establishment of HMOs, which were managed care organizations responsible for providing comprehensive healthcare services to enrolled members. The HMO Act paved the way for the proliferation of managed care organizations across the United States (Robinson, 2004).

Key Components and Strategies of Managed Care

Managed care organizations employ various strategies and mechanisms to control costs and improve the delivery of healthcare services. These strategies include:

1. Utilization Management: Utilization management techniques involve assessing the appropriateness and necessity of healthcare services to ensure efficient use of resources. This may include pre-authorization requirements, second opinions, and clinical guidelines (Kongstvedt, 2007).

2. Financial Incentives: Managed care organizations often use financial incentives, such as capitation and performance-based reimbursement, to promote cost-effective care and encourage providers to deliver high-quality services efficiently (Popejoy, 2018).

3. Coordinated Care: Managed care places an emphasis on coordinating care across different providers and settings to ensure continuity and reduce duplication of services. This is achieved through the use of primary care gatekeepers, care coordination teams, and care management programs (Robinson, 2004).

Impact of Managed Care on Healthcare Delivery

Managed care has had a profound impact on healthcare delivery in the United States. Some of the key effects include:

1. Cost Containment: Managed care’s cost-containment strategies, such as utilization management and financial incentives, have helped control healthcare costs by promoting efficient utilization of resources and encouraging providers to deliver cost-effective care.

2. Shift in Provider-Patient Relationship: The advent of managed care has led to a shift in the provider-patient relationship. Primary care physicians now act as gatekeepers, coordinating and managing the care of patients. Patients are encouraged to choose providers within a network and follow established protocols and guidelines.

3. Emphasis on Preventive Care and Health Promotion: Managed care organizations have placed greater emphasis on preventive care and health promotion initiatives. By implementing preventive measures, managed care aims to reduce the need for costly treatments and improve overall population health outcomes.

4. Integration of Healthcare Services: The rise of managed care has led to the integration of healthcare services by forming networks of providers, including hospitals, clinics, and specialists. This integration facilitates better coordination, continuity, and quality of care for patients.


Managed care has brought about a paradigm shift in the delivery of healthcare services in the United States. Through various strategies such as utilization management, financial incentives, and coordinated care, managed care organizations have been able to control costs, improve quality, and promote preventive care. While managed care has its strengths and critiques, its impact on healthcare delivery cannot be understated. As the healthcare landscape continues to evolve, it is crucial to evaluate and adapt managed care models to ensure that they continue to meet the needs of patients, providers, and the overall healthcare system.