Managed care

ncreasingly, the explosion in scien- tific knowledge is overwhelming both researchers and practitioners in the health professions. The man- aged care pharmacist today needs a con - stant and current sense of the basic phar- maceutical sciences, clinical pharmacy, pharmacy management systems, health policy and ethics, new drug introductions, pharmacoeconomics, and pharmacoepi- demiology. Monitoring the ever-changing pharmaceutical industry is now

Aims This study compared 5-year treatment outcomes of older adults to thoseof middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. Design Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). Measurements Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. Findings Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model eScholarship provides open access, scholarly publishing services to the University of California and delivers a dynamic research platform to scholars worldwide. included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years: female gender was also significant. Conclusions Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

With cultural issues prominent in the United States today and with ongoing rapid changes in health care management and delivery, this paper discusses the shift from a generic-type psychiatry (i.e., assuming that humans the world over are no different, and will react to given stressors in life in the same manner) to one recognizing that cultural beliefs, mores, peer pressure, family expectations, and other ingredients operate in unique combinations in various cultures and ethnic groups. These social and cultural factors can and will impact treatment modalities and outcomes. Literature reviewed herein illustrates the progressive stages of awareness and incorporation of cultural differences and the many ways they impact treatment. Unfortunately, the rise in managed, rationed health care threatens the future of this progression: It is essential that culturally-based managed care programs be developed and funded to ensure the availability of cost-effective treatment, through an integrated system of services, to patients of all cultural and economic backgrounds. Appropriately incorporating patients' cultural background has rapidly become one of the most challenging tasks for psychiatry in the United States. Though the definition of "cultural psychiatry" is difficult to agree upon (Moffic, Kendrick, Lomax, and Reid, 1987), it might more accurately refer to the consideration of the individual's cultural background, as well as that of the clinician; just as there is no generic patient, there is no generic psychiatrist. This introduces two highly variable factors into psychiatric encounters.

Background: Primary care performance has been shown to differ under different models of health care delivery, even among various models of managed care. Pervasive changes in our nation's health care delivery systems, including the emergence of new forms of managed care, compel more current data.

Previous research has shown that pharmacoeconomic (PE) data are considered important but may not be optimally utilized by decision makers. No research has compared the effectiveness of different types of PE models. The purpose of this study was to examine the perceived value and understanding of PE models among decision makers in managed care organizations. The perspective of this study was from research scientists working in the pharmaceutical industry who present PE models to managed care clients. The study objectives were to (1) examine what types of models are best received by decision makers, (2) investigate the barriers to using PE models, and (3) recommend methods for improving PE models. A telephone survey of 39 items was conducted with 20 PE research scientists from various U.S. pharmaceutical and biotechnology companies. Topics addressed included factors contributing to how well PE models are received, barriers to using PE models, and recommendations for improving PE model...

A population-based, retrospective claims analysis was undertaken to explore the economic profile of a nebulized ipratropium and albuterol combination product (DuoNeb ® [DN], DEY, L.P., Napa, Calif). This analysis was performed to review expenditures and resource utilization of patients with chronic obstructive pulmonary disease (COPD) who were taking DN or generic ipratropium and albuterol (dual single agents [DSA]). Cohort selection criteria applied to the PharMetrics managed care claims database yielded 1531 patients: 468 DN and 1063 DSA. Total per-member-per-month (PMPM) expenditures Transmission and reproduction of this material in whole or part without prior written approval are prohibited. 1199 were $36.67 for DN and $52.84 for DSA (∆$16.17; P=.03). Differences in regression analysis adjusted least squares means between DSA and DN were $264.62 (P=.083) for total expenditures and $20.81 (P=.03) for ED costs. Resource utilization reflected expenditure observations; ED visits were 0.93 for DN and 1.33 for DSA (P<.001). Inpatient expenditures (DN $874.97, DSA $1105.80; ∆$230.83) represented the largest portion of total costs: 45% with DN and 54% with DSA. The DN cohort was associated with statistically fewer individuals who reported interruptions (0.78 vs 0.85; P=.003). The DN cohort did not appear to be more expensive than the DSA group, was associated with statistically lower ED expenditures, and included fewer individuals with therapy interruptions. Future analyses should include clinical data to better elucidate the full impact of DN on healthcare resources and compliance in the COPD population.

Objective. The frequency of many adverse events (AEs) associated with low-dose glucocorticoid use is unclear. We sought to determine the prevalence of glucocorticoid-associated AEs in a large US managed care population. Methods. Using linked administrative and pharmacy claims, adults receiving >60 days of glucocorticoids were identified. These individuals were surveyed about glucocorticoid use and symptoms of 8 AEs commonly attributed to glucocorticoid use. Results. Of the 6,517 eligible glucocorticoid users identified, 2,446 (38%) returned the mailed survey. Respondents were 29% men with a mean ؎ SD age of 53 ؎ 14 years; 79% were white and 13% were African American. Respondents had a mean ؎ SD of 7 ؎ 3 comorbid conditions and were prescribed a mean ؎ SD prednisone-equivalent dosage of 16 ؎ 14 mg/day. More than 90% of individuals reported at least 1 AE associated with glucocorticoid use; 55% reported that at least 1 AE was very bothersome. Weight gain was the most common self-reported AE (70% of the individuals), cataracts (15%) and fractures (12%) were among the most serious. After multivariable adjustment, all AEs demonstrated a strong dose-dependent association with cumulative glucocorticoid use. Among users of low-dose therapy (<7.5 mg of prednisone per day), increasing duration of use was significantly associated with acne, skin bruising, weight gain, and cataracts. Conclusion. The prevalence of 8 commonly attributed self-reported glucocorticoid-associated AEs was significantly associated with cumulative and average glucocorticoid dose in a dose-dependent fashion. Physicians should be vigilant for glucocorticoid-related AEs and should counsel patients about possible risks, even among low-dose long-term users.

Bipolar disorder is relatively rare in obstetrics and gynecology (ob/gyn) practice compared with depressive and anxiety disorders, but there is a high risk for poor outcomes for patients and their offspring. Ob/Gyn physicians are assuming increasing responsibility for the care of these patients in today&#39;s managed care environment, working independently or in collaboration with a psychiatrist. The clinical presentation of bipolar patients may include mania and/or depression, in addition to more minor mood fluctuations that accompany the emotional and physical changes of pregnancy. The key issue in the differential diagnosis is to rule out medical, surgical, medication, and substance etiologies of mania that are potentially reversible. Indications for routine, urgent, and emergent referrals to a psychiatrist are reviewed. Treatment for bipolar women considering pregnancy includes prepregnancy planning education, involving the patient, family, psychiatrist, ob/gyn physician, and ma...

To evaluate whether attending diabetes group visits (GVs) leads to lower medical care charges for inadequately insured patients with type 2 diabetes mellitus (DM). Randomized controlled clinical trial. Data were abstracted from financial records for 186 patients with uncontrolled type 2 DM randomized to receive care in GVs or usual care for 12 months. Mann-Whitney tests for differences of means for outpatient visits (primary and specialty care), emergency department (ED) visits, and inpatient stays were performed. Separate charge models were developed for primary and specialty outpatient visits. Because GV adherence is potentially dependent on unobserved patient characteristics, treatment effect models of outpatient charges and specialty care visits were estimated using maximum likelihood methods. Mann-Whitney test results indicated that GV patients had reduced ED and total charges but more outpatient charges than usual care patients. Ordinary least squares estimations confirmed tha...

Objectives. This study analyzed whether inadequate functional health literacy is an independent risk factor for hospital admission. Methods. We studied a prospective cohort of 3260 Medicare managed care enrollees. Results. Of the participants, 29.5% were hospitalized. The crude relative risk (RR) of hospitalization was higher for individuals with inadequate literacy (n=800; RR=1.43; 95% confidence interval [CI]=1.24, 1.65) and marginal literacy (n=366; RR=1.33; 95% CI=1.09, 1.61) than for those with adequate literacy (n=2094). In multivariate analysis, the adjusted relative risk of hospital admission was 1.29 (95% CI = 1.07, 1.55) for individuals with inadequate literacy and 1.21 (95% CI = 0.97, 1.50) for those with marginal literacy. Conclusions. Inadequate literacy was an independent risk factor for hospital admission among elderly managed care enrollees.

This paper examines factors associated with differences in managed care penetration across geographic areas. Two alternative measures of managed care penetration are considered: the percentage of revenue physicians received from managed care contracts and market survey data on enrollments in managed care plans. Results are similar for both types of measures. Our analysis suggests that demographics, labor market characteristics and supply side variables including the level of concentration in hospital markets, hospital occupancy rates and the practice organization patterns of physicians are all important determinants of managed care penetration. q 1998 Elsevier Science B.V. All rights reserved.

The purpose of this study was to develop a current and comprehensive model of physician job satisfaction. Information was gathered by (1) analysis of open-ended responses from a large group practice physician survey in 1988, and (2) analysis of focus group data of diverse physician subgroups from 1995. Participants were 302 physicians from large-group practices and 26 participants in six focus groups of HMO, women, minority, and inner-city physicians. Data were used to develop a comprehensive model of physician job satisfaction. The large group practice survey data supported the key importance of day-to-day practice environment and relationships with patients and physician peers. Future concerns focused on the effect of managed care on the physician-patient relationship and the ability of physicians to provide quality care. Focus groups provided contemporary data on physician job satisfaction, reinforcing the centrality of relationships as well as special issues for diverse physician subgroups of practicing physicians. New variables that relate to physician job satisfaction have emerged from economic and organizational changes in medicine and from increasing heterogeneity of physicians with respect to gender, ethnicity, and type of practice. A more comprehensive model of physician job satisfac-tion may enable individual physicians and health care organizations to better understand and improve physician work life.

In an effort to bridge the gap between service need and service utilization, an urban based, university-affiliated children&#39;s psychiatric outpatient clinic implemented a program which provides mental health services in inner city schools. Since impressions of school and mental health personnel affirmed the effectiveness of such services, an evaluation of this program was conducted, despite the difficulties inherent in implementing research in &quot;naturalistic settings.&quot; A clinic sample of children (N = 220) was compared with a sample served in the urban schools (N = 256). The findings revealed that both sets of children showed improvement as indicated by the Children&#39;s Global Assessment Scale (C-GAS) and Global Assessment of Functioning Scale (GAF). The improvement was comparable, even though the school children were seen for a slightly shorter period of time (an average of 5 versus 8 months) but had an equally frequent level of service (3 sessions per month in each s...

Background: To meet the challenge of an aging population, providers and payors must optimize chronic wound care outcomes and contain costs. Objective: To explore the costs, outcomes, and effects of outcomes on costs of pressure and venous ulcer woundcare protocols. Design: Modeling study using outcomes from a literature review. Methods: The cost of 12 weeks of wound care was modeled for a hypothetical managed-care plan. This included 100 000 covered lives and used a peer-validated wound care protocol. Only modalities with a pooled evidence base of at least 100 wounds were used to populate the model. Costs excluded supportive treatments. Results: 26 studies of three pressure ulcer protocols (n = 519) and three venous ulcer protocols (n = 883) qualified for inclusion in the models. After 12 weeks, the weighted average proportion of ulcers healed, and cost per ulcer healed, ranged from 48 to 61% and from $US910 to $US2179 (2000 values) for pressure ulcers, and from 39 to 51% and $US1873 to $US15 053 for venous ulcers. For a hypothetical managed-care plan, the difference between the least and most costeffective modalities was $US1.9 million for pressure ulcers and $US5.8 million for venous ulcers. Observed differences were generally attributable to variances in outcomes and cost differences related to frequency of dressing changes. Pressure ulcer care takes place in inpatient care settings; venous ulcers are managed on an outpatient basis. Physician visit frequencies are once every four weeks for pressure ulcers and once each week for venous ulcers. Wound sizes ranged from 2.5cm 2 to 5.6cm 2 for pressure ulcers and 5.4cm 2 to 10cm 2 for venous ulcers. All patients with pressure ulcers required pressure relief, nutritional support and incontinence management; venous ulcers required gradient compression. Costs per patient healed were lowest for pressure ulcers with hydrocolloids and highest ORIGINAL RESEARCH ARTICLE

Although it is more usual to use the term Ôperinatal lossÕ to refer to the loss of a baby of more than 500 g up to the first 28 days of life, the term has been avoided in this article where possible because it scientises women's experiences of loss in a way that does not represent the intensity or trauma of this profound experience. The authors have tried throughout to honour that experience.

Cultural competence has gained attention as a potential strategy to improve quality and eliminate racial/ethnic disparities in health care. In 2002 we conducted inter- views with experts in cultural competence from managed care, government, and academe to identify their perspectives on the field. We present our findings here and then identify re- cent trends in cultural competence focusing on health

The book defines and discusses eight key elements of a family-centered approach to care for children with chronic illnesses and special health care needs: (1) recognition that the family is the constant in the child's life, while the service systems and personnel within those systems fluctuate; (2) facilitation of parent/profeusional collaboration at all levels of health care; (3) sharing of unbiased and complete information with parents about their child's care on an ongoing basis in an appropriate and supportive manner; (4) implementation of appropriate policies and programs that are comprehensive and provide emotional and financial support to meet the needs of families; (5) recognition of family strengths and individuality and respect for different methods of coping; (6) understanding and incorporating the developmental needs of infants, children, and adolescents and their families into health care delivery systems; (7) encouragement and facilitation of parent-to-parent support; (8) assurk.nce that the design of health care delivery systems is flexible, accessible:, and responsive to family needs. The document also offers the following: (1) a brief review of selected research studies; (2) a series of checklists for professionals and parents, states, communities, professional training programs, hospitals, and research investigations; (3) lists of

As part of a study into the effect of co-managing the pre-and postoperative care of patients undergoing cataract surgery, a literature review has been carried out that includes assessment of the extended role of the nurse. Although this concentrates on ophthalmic nursing, general implications for the extension of nursing roles have also been identified. Discussion of what is meant by the term 'extended role' is followed by examples from general and ophthalmic nursing practice. Possible rationales behind the moves to encourage nurses to extend the scope of their practice are then suggested; these include cost effectiveness, improved patient care, the freeing of medical time and professional status enhancement. The issue of nurses' competence and the legal and ethical implications of extending nursing roles are then raised. It is advocated that nurses and doctors collaborate to ensure that appropriate standards of care are upheld. The paper concludes with the following recommendations: 9 Ensuring acceptable levels of competence in nurses who extend their roles 9 Discussion of the case for statutory regulation relating to role extension 9 The need for more research into co-management of care and the extended role of the nurse

This study examined the measurement quality of an abbreviated version of the Caregiver Strain Questionnaire. The CGSQ-Short Form 7 (CGSQ-SF7) is practical for routine assessment of objective and subjective internalized caregiver strain. The subjective externalized subscale is not included in the CGSQ-SF7. Findings indicate that the reliability and validity of the shortened objective and subjective internalized subscales are comparable to the original. Examination of construct validity suggested that caregiver, youth, and clinician ratings of child clinical severity were related to objective caregiver strain. However, youth and clinician ratings of child clinical severity were not related to subjective internalized caregiver strain.

By 2022, the Indian healthcare industry is projected to rise to US$ 372 billion, powered by increased revenue, enhanced health literacy, lifestyle diseases and increased access to insurance. The healthcare industry is a significant and developing research context that can be defined by a strong emphasis on individualized products and a distinguished need for a variety of dispersed supply chain players to collaborate. The ever-rising cost of health care, combined with the need for health care services, the lack of convenient access to affordable health care for people from low-income groups have contributed to the rise of health insurance as an alternate method for funding health care. This article attempts a scoping review of literature on Indian health insurance and the major topics discussed in those articles. Review of the developments and the issues in the Indian insurance industry would enable a clearer understanding of the current level of research and the future directions which is the motivation for the stud

Bipolar disorder is a less common biologic disorder in primary care than are depressive and anxiety disorders, but there is a high risk for poor outcomes for patients. Primary care physicians (PCPs) are assuming increasing responsibility for the care of these patients in today's managed care environment, working independently or in collaboration with a psychiatrist. The PCP needs to carefully assess patients presenting with depression, since many are bipolar. The PCP must then skillfully manage these patients because of the significant morbidity and mortality associated with the disorder. This article outlines a diagnostic approach for patients in primary care practice who present with mood symptoms. The article also presents a management strategy for those who are diagnosed with bipolar disorder, including patients who are considering pregnancy or who are pregnant.

The purpose of this review article is to provide an overview of behavior therapy. Both historical and contemporary perspectives will be addressed. Particular attention will be given to description of behavioral treatment interventions. Description of alternative treatment options, including psychopharmacology, will also be reviewed. The article will conclude with an examination of the importance of behavior therapy in the current managed care environment. © 1999 Elsevier Science Ltd IN TERMS of therapy orientations, behavior therapy is a relatively new orientation that became popularized in the 1960s. It is one of the few therapy orientations that evolved from scientific investigations; thus, the discipline emphasizes empiricism in both attempting to understand psychopathology as well developing treatment approaches. In its striving for empiricism, behavior therapy focuses only on aspects of human behavior that can be quantified; aspects of human behavior that are inferential (e.g., unconscious conflicts) cannot be reliably measured due to the lack of tangibility. Therefore, inferential concepts do not merit consideration within the behavioral approach.

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but these laws have had mixed results. This essay argues that community pharmacy&#39;s patient counseling conundrum can be solved through additional moral education persuasion, not through additional legal mandates.

Faced with high drug expenditures in an environment of cost containment, drug formulary systems, particularly in managed care, have become more dependent on pharmacoeconomic evaluations to assess the value of new products. Within pharmacoeconomics (PE), cost-effectiveness analysis (CEA) is the most commonly used method. However, current methodological concerns about CEA have limited its practical contribution to the formulary process. Advances in analysis are likely to improve the relevance of CEA over time. The purpose of this paper is to review CEA, its limitations, and its applications in formulary decision making in order to promote greater utility of CEA for managed care pharmacists. Enhancements to CEA, such as the development of modeling software, rank-order stability analysis, cost-consequence analysis (CCA), and budget impact analysis are discussed. A combined method of CCA-CEA and standardized guidelines are suggested to improve the impact of CEA in the drug formulary proc...

ttention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood mental health conditions, with 3% to 7% of children affected by this disorder. 1-5 Core symptoms of ADHD include inattention and hyperactivity/impulsivity. ADHD has long been recognized as a mental health disorder in children, and research has shown that children with this disorder experience significant impairments in psychosocial functioning. Compared with children without the disorder, those with ADHD have higher rates of academic difficulties, such as learning disabilities and early school departure 6-8 ; experience social difficulties 9-11 ; and are likely to have coexisting psychiatric conditions. Although ADHD has traditionally been thought of exclusively as a childhood disorder, research has indicated that symptoms often continue into adulthood. Despite the fact that epidemiological studies of adult ADHD have not been conducted, this disorder has been estimated as occurring in approximately 4% of adults. 14 Given the prevalence of the disorder, associated negative outcomes, and presence over the life course, identification and treatment are of primary concern.

Quality function deployment(QFD) provides a systematic way to translate the voice of the customer/patient into appropriate technical requirements.
• QFD, although rarely used in healthcare, can help organizations focus on their patients’ needs.
• QFD was used to help a managed care organization redesign its member handbook.

Many countries are importing managed care and price competition from the US to improve the performance of their health care systems. However, relatively little is known about how power is organized and exercised in the US health care system to control costs, improve quality and achieve other objectives. To close this knowledge gap, we applied social exchange theory to examine the power relations between purchasers, managed care organizations, providers and patients in the US health care system at three interrelated levels: (1) exchanges between purchasers and managed care organizations (MCOs); (2) exchanges between MCOs and physicians; and (3) exchanges between physicians and patients. The theory and evidence indicated that imbalanced exchange, or dependence, at all levels prompts behavior to move the exchange toward power balance. Collective action is a common strategy at all levels for reducing dependence and therefore, increasing power in exchange relations. The theoretical and r...

Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential. Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR). Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices. Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction. Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction. Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.

OBJECTIVE: To assess use of cholesterol-lowering therapy and related beliefs among middle-aged adults after myocardial infarction. DESIGN: Telephone survey and administrative data. SETTING: National managed-care company. PARTICIPANTS: Six hundred ninety-six adults age 30 to 64 surveyed in 1999, approximately 1 to 2 years after a myocardial infarction. MEASUREMENTS: Use of cholesterol-lowering drugs, beliefs about the importance of lowering cholesterol, and knowledge of personal cholesterol level, adjusting for demographic and clinical factors with logistic regression. MAIN RESULTS: Among respondents, 62.5% reported they were taking a cholesterol-lowering drug. In adjusted analyses, these drugs were used significantly less often by African-American patients and those with congestive heart failure or peripheral vascular disease, and more often by college graduates, patients with hypertension, and those who had seen a cardiologist since their myocardial infarction. Lowering cholesterol was viewed as``very important'' by 87.1% of patients, but significantly less often by smokers and more often by those who had undergone coronary angioplasty or bypass surgery. Only 42.5% of respondents knew their cholesterol level, and this knowledge was significantly less common among less-educated or less-affluent patients, African-American patients, and patients who smoked or had diabetes or peripheral vascular disease. CONCLUSIONS: Although most patients recognized the importance of lowering cholesterol after myocardial infarction, several clinical and demographic subgroups were less likely to receive cholesterol-lowering therapy, and many patients were unaware of their cholesterol level. Health-care providers and managed-care plans can use these findings to promote cholesterol testing and treatment for patients with coronary heart disease who are most likely to benefit from these efforts.

Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by ideological changes with discourses accepting the inexorable nature of public sector reform.