The two faces of managed care. Wonkonian managed care.
Managed care - two-faced? No, many-faced. By which I mean the many entities in the healthcare system all mean something different when they use the term “managed care.” These meanings are based on the ideas we have just considered, but none conceive of, promote, or apply managed care in its purest form. “Pure” managed care does not exist in the wild.
Fortunately, the most prominent variations in managed care fall into just two major schools of thought; these happen to be those same schools we’ve already had the pleasure of meeting - the Wonkonians and the Gekkonians.
Wonkonian managed care
Wonkonians believe, you will recall, that the problems in our healthcare system can be traced to human weaknesses (greed on the part of physicians, patients, and corporations). Fixing these problems depends on setting public policy and promulgating governmental regulations. Managed care offers to remove some of the choices humans have to make in delivering healthcare (choices easily colored by greed) and to replace them with externally generated processes and procedures. Philosophically, it’s a good fit.
Because Wonkonians like and believe in the ideas behind managed care, the people who conceived of and developed those ideas - academics, healthcare experts, government commissions, economists and editorialists - tend to gravitate to the Wonkonian camp. Wonkonians espousing the ideals of managed care tend to sound like purists. They are proselytizers who believe in applying continuous quality improvement, critical pathways, information management, and other efficiencies of industrial management to healthcare. Because of their obvious sincerity, and because many of their ideas have considerable merit, it is easy for right-minded folks to fall in with this crowd.
What differentiates Wonkonians from true managed care purists is in what they mean by the word “managed.” In classic managed care, “manage” refers to the application of management principles such as standardization. To Wonkonians, “manage” means “regulate.” Managed care is a convenient tool for advancing their basic belief in policies and regulations to control human behavior. The specific recommendations put forth by Wonkonians have much more to do with establishing a centralized regulatory structure for healthcare than they do with managed care principles. To them, a system of strict regulations has become synonymous with managed care.
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