Part 1: Non-managed care techniques to improve clinical practice

Introduction

In recent years managed care became a promise of cost control and reduction of unnecessary services utilization, especially in countries with very limited resources. Most LMICs included it early in their reform packages (Tollman et al., 1990). In spite of scarce empirical evidence on the implementation of managed care techniques in this setting (Luck & Peabody, 2002) and intense debates surrounding their introduction in countries such as the USA (Christianson et al., 2005; Simonet, 2005), these techniques were increasingly exported to LMICs.

In this chapter we briefly analyze the results of the introduction of managed care techniques in different environments, explore issues related to the resulting loss of autonomy in clinical practice and offer alternative techniques to improve quality of health care.

What is managed care and what are its results?

The literature offers different approaches and definitions of managed care, probably because it does not convey one single, common concept, but a set of principles and interwoven practices (born in the 1980s in the USA to control costs).

Managed care techniques aim at providing incentives for productivity and efficiency while improving quality of services. They should be distinguished from the organizations which implement them. In this chapter we will attempt to focus on the former and address, in the first instance, clinical mechanisms designed to improve clinical decision making.