When do developing countries adopt managed care policies and technologies? Part II: Infrastructure, techniques, and reform strategies.

Abstract

OBJECTIVES: To specify the essential infrastructure elements required to implement managed care techniques successfully in a developing country, once the necessary macroeconomic preconditions for managed care have been met. Also, to describe how managed care techniques can be integrated into health system reform strategies. STUDY DESIGN AND METHODS: Analysis of available developing country health system and healthcare spending data, review of the available literature, and authors' experience evaluating healthcare reform in developing countries. RESULTS: Successful managed care relationships among payers, providers, and patients rely on several essential infrastructure elements: enabling legislation; regulatory mechanisms to administratively correct health and insurance market failures; enforceable contracts; and formal groups or associations of providers. Once these infrastructure elements are in place, a developing country government can consider implementing 1 or more managed care techniques, including payment strategies, demand-side techniques, and utilization management. CONCLUSIONS: Governments in many developing countries can take deliberate steps to accelerate the evolution of certain macroeconomic preconditions--human capital and information systems--and essential infrastructure elements necessary to support managed care techniques. They may then choose to experiment carefully with implementing specific managed care techniques, with consideration given to how the managed care techniques can promote primary care.