Changes in health care financing: effects on the delivery of health care services in the 1990s.

The evolution of health care financing has had a profound effect on the delivery of health care services. Autonomous, provider-directed care with fee-for-service reimbursement combined with expensive medical technology and an overabundance of providers has led to increasing medical costs. In an effort to reduce spending, payers are responding by demanding that providers regulate clinical and financial outcomes under managed care contracts. These contractual arrangements are administrated by a variety of managed care organizations and are forcing providers to coordinate care along the full continuum. Cardiovascular health and disease management is particularly affected because billions of health care dollars are consumed in this area. This article explores the evolution of the current crisis in health care financing and its effects on providers and payers. Future opportunities for cardiovascular providers in this changing health care environment are briefly discussed.