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Health Aff (Millwood). 2018 Sep;37(9):1425-1430. doi: 10.1377/hlthaff.2018.0433.

With Roots In California, Managed Competition Still Aims To Reform Health Care.

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Alain C. Enthoven is the Marriner S. Eccles Professor of Public and Private Management, emeritus, in the Graduate School of Business, and senior fellow emeritus (by courtesy) at the Freeman Spogli Institute for International Studies, both at Stanford University, in California.
Laurence C. Baker ( ) is a professor of health research and policy and senior fellow at the Stanford Institute for Economic Policy Research, Stanford University.


Managed competition is a concept that was born in California and has achieved a measure of acceptance there. As California and the United States as a whole continue to struggle with the challenge of providing high-quality health care at a manageable cost, it is worth asking whether managed competition-with its tools for harnessing market forces-continues to hold promise as a means of improving value in health care, and whether the standard conceptualization of managed competition should be modified in any way. In this article we reflect on four aspects of California's health care ecosystem that provide insights into these questions: integrated delivery systems, patients' choice of health plans, quality measurement, and new health care marketplace architectures such as Covered California and private insurance exchanges. Overall, while California's experience with managed competition has resulted in some challenges and adaptations, it also gives reason to believe that principles of managed competition continue to have the potential to be a powerful force toward creating a more efficient health care system.


California; Covered California; Integrated Delivery; Managed Competition

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