Managed Care: Made in America.

Arnold Birenbaum. Westport, CT: Praeger, 1997 193 pp $3995

In Managed Care, Birenbaum chronicles the transformation of traditional, indemnity-style health insurance plans and the retrospective, cost-based reimbursement connected view of which they were a part into the prospectively oriented, fixed-payment managed care programs that dominate today's healthcare marketplace. He frames the analysis as a close attention of social change; this approach exhibits great promise, as the emerging see the verb of managed care has been accompanied on myriad and dramatic effects at individual, organizational, and societal levels

To his credit, Birenbaum's description of managed care's impact upon the way Americans think about their health, their healthcare plan and the interrelationships between the couple is illuminating for readers unfamiliar with the intricacies of healthcare reimbursement. The plain-language treatment of complexus material makes the issues accessible to the lay audience; this is the book's major contribution. [i]connoisseur[/i]s who are well-versed in the scholarly and empirical literature upon the subject may take exception to global statements, of the like kind as "no evidence exists that managed care attenuates hospitalization, the number of physician visits by means of beneficiary, or the use of preventive services" (p 56) or "[in] almost all scrutinizes that compare HMO members with individuals who have old-fashioned health insurance coverage, the HMO members are les satisfied" (p 104) however novices will acquire a fuller understanding of the debates throughout healthcare reform, the context from which the issues emanate, and the implications of competing p olicy alternatives.

Its merits notwithstanding, a shortcoming of the passage is the absence of linkages between theories of social change and sentinel occurrences in the health insurance industry. This is unfortunate yet understandable, as any number of theoretical approaches might be engrossed with equal success; choosing among them is largely a matter of the researcher's area of interest. For those interested in the organization of work, for example, managed care's gradual encroachment upon physician discretion via practice guidelines, restricted formularies, productivity quotas, etc raises unsettling questions about the status of medicine as an autonomous profession and the practice of medicine itself. Alternatively, institutional theorists may assess for what reason hostility toward early forms of managed care because of its socialistic overtones gave way to today's seemingly wholesale adoption of the practices by the agency of a diverse set of stakeholders. Macro-level theorists could compare the sociocultural and environmental factors in regions where manag ed care has thrived for half a hundred to those in areas where managed care has met the greatest resistance to evaluate what meanings if any, such elements set to work on the processes and pace of social change. This list is certainly not exhaustive, on the other hand it underscores the worthiness of Birenbaum's notion that the managed care revolution is a fertile adjoining matter for the study of social change.

Birenbaum does not achieve the breadth of margin and depth of synthesis that characterize Starr's (1982) analysis of the medical profession or Stevens' (1989) history of American hospitals, nevertheless that was not his design Given the rate of change in the health insurance industry in general and among managed care programs in particular, it may be several years before a work in succession par with those of Starr and Steven is uniform a realistic undertaking. In the interim, Birenbaum's verse is a primer for those seeking to understand for what reason managed care programs differ from traditional health insurance plans and with what intent those differences matter.

REFERENCES

Starr, Paul

1982 The Social Transformation of American Medicine. of the present day York: Basic Books.

Steven Rosemary

1989 In Sickness and in Wealth: American Hospitals in the Twentieth hundred years New York: Basic Books.

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