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Medicine and Commerce. 1: Is Managed Care a “Monstrous Hybrid”?

Frank Davidoff, MD, Editor
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Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(6):496-499. doi:10.7326/0003-4819-128-6-199803150-00012
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The intrusion of commerce into medicine during the past decade has had a great deal to do with creating the tangled web of administrative and financial systems that we know as managed care. Although these new systems have brought about new efficiencies and have slowed the rate of increase in medical costs [1], they have also brought with them a growing sense, both in the profession and the public at large, that something profoundly wrong is happening to medicine [2]. Various explanations for this “angst” have been advanced, many of them reasonable but none, in my view, sufficient to account for the depth and degree of malaise abroad in the land. This editorial explores the deep “seismic shifts” that I believe are the major sources of our professional and public angst and suggests some ways of coming to grips with these root causes.

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