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Provides a review and analysis of the ambulatory patient groups classification system. Discusses a review of the history, development and implementation process. Concludes that in the ongoing efforts to move towards full‐managed care in the not‐so‐distant future, ambulatory patients groups are another potential cost‐cutting remedy for current health care providers and that future research into this issue is a must for public policy makers.

This paper focuses on Medicare risk contracting in the USA. The issue of the current method of reimbursement versus Medicare risk contracting is explored. Risk sharing and payment mechanisms are described and analyzed. The strengths and weaknesses (score‐ card) of Medicare beneficiaries entering HMOs are reviewed. Finally, the issue of selection bias in Medicare HMOs is discussed regarding future implementation strategy.

Although gainsharing is an old organizational development intervention, the literature has not sought to provide an integrative framework for its study. The purpose of this article is to provide a review of its conceptual perspectives, organizational theory, and design to meet the need of such future research.

Substance abuse continues to increase and permeate all sectors of US society including the medical profession. This article details the importance of testing everyone associated with health care organizations, including physicians, as a means of protecting patient welfare, increasing quality of care, and reducing negligence lawsuits, as well as providing treatment and recovery opportunities for those with addictions.

Examines the primary studies which have contributed to dental care research. By reviewing background information, lays a foundation for the review of the current empirical evidence, which examines the effect of dental insurance coverage on the oral health of the American population, as well as the utilization and demand for dental services. Raises questions and implications for future research and practice.

Illustrates several issues associated with the effects of advanced information technology on the organizational design function. Explores the relationship between technology and organizational design. Cites some early empirical studies and identifies some contemporary challenges. Also mentions implications for new organizational forms within the context of a realigned health‐care industry perspective. Concludes that organizational theorists and information systems scholars must integrate their efforts in order to appreciate the changes within this field of management theory, thought and practice.

As the health‐care industry undergoes major change, a method of “accounting for quality” has become a key factor in health services delivery and fiscal accountability. This article examines several aspects of health care that inhibit the development of common methods of defining and accounting for quality. Key issues and characteristics of the health‐care market are addressed and the article provides a synthesis of these obstacles to the process of deriving common measures and standards of quality that may be utilized by the health‐care industry for financial decisions.

The development of managed care plans is the most dramatic change in the USA’s health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations, and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers’ rights, and ensure better quality health care from managed care programs.

Provides a review and analysis of Medicare health maintenance organizations in the USA. The Porter model of industry structure is used. Discusses the issues of suppliers, buyers, market entry and substitutes. Indicates there is currently no intense rivalry among Medicare risk‐based HMOs. However, the Porter model reveals crucial information regarding the forces which drive industry competition. Trends in the field of managed care and Medicare financing continue to be a real challenge regarding future research.

With a defined population served, contracted provider panels and the nature of care delivery integration, managed care has provided a solution, though not a panacea, to provide equitable services, standardized and prevention oriented cares to its enrolled members. Combined with the earmarked capitation reimbursement system and a series of cost containment and utilization review techniques, managed care has also demonstrated potently its capacity in cost‐saving and quality promotion. Presents steps and measures related to managed care that federal government has taken to manage care and contain cost. It is crucial to identify and promulgate best practices continually, while managing utilization of resources for improving health care, containing cost, and equalizing medical care access to a greater proportion of the population. Concludes that it may take time for a universal adoption of managed care. However, Americans may actually benefit more from having a standard level of health care that managed care could achieve and provide.