December 2004
Journal of Health Politics, Policy and Law
, Vol. 29, No. 6 (December 2004)
Lawrence D. Brown, Elizabeth Eagan
The recent decline, indeed perhaps dismantling, of managed care is sometimes
treated as both consequence and cause of the political reempowerment of medical
providers, whose professional dominance managed care had challenged. Drawing
evidence from Round III of the Community Tracking Study of the Center for Studying
Health System Change, this article reviews the politics of four “arenas”
of managed
care regulation—prompt payment, mandated benefits, external appeals, and
financial solvency—and concludes that the power of providers is contingent
on patterns
of coalition and conflict that differ across the discrete arenas. The zero-sum
connotations
of the “de” and “re” empowerment of providers under managed
care fail to
capture the subtlety of providers’ search for fresh cultural, economic,
and political
resources in shifting policy contexts.
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