The managed health care scenario: Challenges to future medical training

The health of academic health centres in the USA is closely linked with their success in adapting to, and participating in, the changing health care delivery system. That system is fast becoming 'managed care' in which third-party payers pay a fixed amount of money to a health provider group to manage all the care for individuals enrolled in their plans. Academic Health Centres have relatively little experience in this new environment, but their contribution to health policy development, to the training of all health professionals and to clinical outcomes research, as well as their service to underserved populations are critical to the quality of health care services in the nation. Managed care organizations are being asked to be partners in the shaping of academia for the education of future health professionals by participating in education and research. Curricula for medical students and residents relevant to managed care are reviewed. Barriers to achieving academic-managed care are described, and strategies for overcoming these barriers are discussed. Recommendations for institutional change, at both academic health centres and managed care organizations are suggested.