GSE Publications

Document Type

Journal Article

Date of this Version


Publication Source

Annals of Internal Medicine





Start Page


Last Page



We are currently witnessing a radical change in the health care system in the United States as a result of the managed care juggernaut. Driven by the imperative to stem increasing health care costs, managed care seeks to save money by “managing” health care utilization and narrowing the choices available to health care consumers. Although both cost-saving strategies are effective, they also present a potential threat to quality of care. As HEDIS and other measures of quality are revised, physicians must establish guidelines for quality of care that support the burgeoning managed health care environment. In developing these guidelines and measures, two important trends must be acknowledged and addressed. First, managed care was formerly confined mostly to middle class populations but now envelops many more diverse and vulnerable groups, including Medicaid, Medicare, and minority populations [1]. Second, providing care within a managed care environment requires attention to the population of “covered lives” in addition to individual patients.

Copyright/Permission Statement

Reproduced with permission from Elizabeth Mackenzie. Cultural Competence: Essential Measurements of Quality for Managed Care Organizations. Annals of Internal Medicine. 1996 vol 124: 919-021. ©American College of Physicians.



Date Posted: 17 November 2016

This document has been peer reviewed.