The challenge of managed care in rural West Virginia.

West Virginia faces a particularly difficult challenge in organizing its health care system for managed care. The rural nature of the state, the shortage of primary care practitioners, few large employers, and the predominant role played by federal and state health care purchasers have hindered managed care development in the state. The crisis in the cost of health care and discussions of health care reform have now created interest in developing prepaid managed care by both payers and providers. In the last three years, several initiatives have paved the way for a more organized approach to the delivery of health care. This article describes the current health care environment in West Virginia and the efforts underway to prepare for system change.