Managed care and the US health care system: a social exchange perspective

• Published in: Social science & medicine (1982) Vol. 54; no. 8; pp. 1167 - 1180
• Main Authors: Grembowski, David E, Cook, Karen S, Patrick, Donald L, Roussel, Amy Elizabeth
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.04.2002; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Biological and medical sciences; Competition; Delivery of Health Care - economics; Delivery of Health Care - organization & administration; Exchange Theory; General aspects; Health care; Health Care Coalitions; Health care expenditures; Health care policy; Health Care Sector - organization & administration; Health Care Services; Health care systems; Health Policy; Health policy Managed care Price competition Managed competition Health care systems Exchange theory United States; Health services; Health systems. Social services; Humans; Interprofessional Relations; Managed care; Managed Care Programs - economics; Managed Care Programs - organization & administration; Managed Care Services; Managed Competition; Managed health care; Management; Medical sciences; Models, Organizational; Physician-Patient Relations; Power (Psychology); Power relationships; Price competition; Private Sector; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public Sector; Social Behavior; Social exchange theory; Theory; United States; United States of America; USA; United States; North America; America; United States > US; Price competition; Health policy; Health care systems; Managed care; United States; Managed competition; Exchange theory; Exchange; Health system; Price; Quality; Social aspect; Cost control; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(01)00087-9

Many countries are importing managed care and price competition from the US to improve the performance of their health care systems. However, relatively little is known about how power is organized and exercised in the US health care system to control costs, improve quality and achieve other objectives. To close this knowledge gap, we applied social exchange theory to examine the power relations between purchasers, managed care organizations, providers and patients in the US health care system at three interrelated levels: (1) exchanges between purchasers and managed care organizations (MCOs); (2) exchanges between MCOs and physicians; and (3) exchanges between physicians and patients. The theory and evidence indicated that imbalanced exchange, or dependence, at all levels prompts behavior to move the exchange toward power balance. Collective action is a common strategy at all levels for reducing dependence and therefore, increasing power in exchange relations. The theoretical and research implications of exchange theory for the comparative study of health care systems are discussed.