[Do we really want managed care?].

In spite of the mounting criticism levelled at Managed Care, it is still being discussed in Germany as a promising concept expected to improve both the quality as well as the cost effectiveness of health care. However, this discussion focuses largely on the theoretical advantages of Managed Care in comparison with the German health care system. To examine whether these advantages of Managed Care are actually realised once the concept is broadly implemented, we analysed the contemporary effects of managed care on patients and physicians in the US. This revealed that while Managed Care has for the time being slowed the rise in health services expenditures, major shortcomings of the concept are evident: Patients express a loss of trust in the health care system and complain about decreased choice, poor continuity of care, and persistent high personal health care cost. Physicians complain about increasing financial risks imposed on them, about curtailed therapeutic freedom, and generally the way they must now conduct their medical practice. Law-makers, in turn, react to the defects of the Managed Care industry by imposing increasing external controls and regulations. All in all, Managed Care as implemented by many of the US systems does not appear to fulfill the positive expectations of the two principal stakeholders--patients and physicians. Instead, a large number of side effects are in evidence that appear to make a transfer of the American concept to the German health care system far from desirable.