14. Preliminary Remarks

“After a turbulent decade of trial and error, that experiment can be characterized as an economic success but a political failure”, stated Robinson (2001, p. 2622), for the United States some years ago. In particular, the question was raised of whether MCOs used “managed care” or “managed costs”. Critics emphasise that MCOs focused more on managing the cost of care and less on managing healthcare. Minimal attention was given to the preferences and expectations of the insured as well as those of service providers. This led to the situation that although managed care was considered to be useful in theory, there are considerable problems in its implementation. There is hardly clarity on the instruments and organisational forms that belong to managed care while fully accepted methods, such as working according to guidelines or disease management, are not seen as connected to managed care. In general, the following four main objectives and expectations are associated with managed care will be discussed: (a) the cost of managed care, (b) quality effects of managed care, (c) access effects of managed care, (d) acceptance of managed care.