Managed Care and Public Health.

Managed Care and Public Health Halverson PK, Kaluzny AD, McLaughlin CP. Gaithersburg, MD 20878, Aspen Publishers Inc, 1998, hardcover, 461 pp, $49.

Government-dominated health care reform tailed to gain acceptance in the 1990s just as previous health care reform debates failed in the 1930s, 1950s, and 1970s. In the absence of government reforms, managed care has become the predominant form of health care delivery in the United States, driven by the privatization of hospitals and other health care providers. As profit-driven health care providers consolidated, networked, and formed integrated delivery' systems, capitated risk-sharing reimbursement replaced fee-for-service reimbursement. Organizations now compete fiercely for scarce health care dollars by managing risk and rationing care.

This book presents a timely examination of the intersection between public health and managed care. Public health has long been primarily the responsibility of the government. America's public health system was founded on the belief that society has the right to expect the government "to create and assure the context in which people can be healthy." However, in 1988, the Institute of Medicine (IOM) reported that America's public health system was in disarray and unable to deliver on these expectations. In order to address this problem, in 1996, IOM called for a strong partnership between public agencies and managed care organizations to jointly provide for the infrastructure and delivery of health care services to the public.

The text is divided into 3 parts. Part 1, "Current Themes in Public Health and Managed Care," is an overview of the current trends anti issues facing managed care and public health organizations. Chapter 1 outlines the opportunities and challenges facing managed care and public health as they come together to ensure health care availability, accessibility, and quality. Chapter 2 describes in detail the organization of public health and federal programs such as Maternal and Child Health Services. The third chapter in part I describes the stages of managed care's market maturity; assesses the impact of managed care on access, cost, and quality; and defines the vocabulary and acronyms associated with managed care. Chapter 4 describes the privatization of public hospitals and the challenges they face as they attempt to serve the public and operate at a profit.

Chapter 5 concludes the first part of the book by examining the privatization phenomena and the alternatives and classification options for privatizing. It also describes TennCare, the capitated managed care program for the state of Tennessee. This first part of the text is an information-rich presentation that is a must read for anyone who interacts with managed care, especially with managed care organizations operating in the public health arena.

Part 2 describes the application of the managed care model to public health subsystems, including Medicaid, Maternal and Child Health Services in Texas, mental health care, and substance abuse services. The final chapter of part 2 describes the controversial role of quality assurance in public health and the role of the private sector.

The third and final part of the book is entitled "Case Studies in Public Health and Managed Care." This section contains 8 chapters presenting timely case studies from various parts of the country. The case studies cover recent developments in a variety of different markets, describing, in detail, how the private sector and public health have come together. The case studies vary from describing a quality-improvement strategy in New Jersey to privatizing the mental health system of King County, Washington.

This is a serious text about an important facet of health care in the 1990s that is poorly understood by most health care practitioners. Despite having 25 contributors with different backgrounds, the book flows evenly from chapter to chapter. Although the chapters are written to stand alone and may be easily read in random order, there is a benefit to reading parts 1 and 2 in order because the early chapters provide the reader with the necessary educational foundation to best use the lessons of the case studies.

I thoroughly enjoyed this book. I recommend it to physical therapy practitioners who are responsible for the strategic growth, marketing, and financial performance of their rehabilitation departments. It is a particularly important read for practitioners who must manage public health demands within the framework of a managed care organization.

Mr Tannenbaum is Clinical Operations Director of the Outpatient Rehabilitation Division at Nova Care.