Historical Timeline of Managed Care

1929(The beginning of the Great Depression) concept of pre-paid health plans introduced

 1930s-1950s Catastrophic insurance became widespread

1937Kaiserstaff model HMO began

World War II (1939-45)  Health insurance linked to employment; labor unions hired doctors, constructed clinics and hospitals, and supplied prepaid medical services in the coal regions in West Virginia and Kentucky. Indemnity  insurance

1945 National health insurance proposed by President Truman

1946 Hill-Burton Act: Gave 4 billion dollars to 6900 hospitals. Funded 800 new hospitals.Provided funds to train interns and residents.Promoted the construction of not-for-profit hospitals in rural areas.

1950s Veteran's Affairs system developed under General Omar Bradley. The VA hospitals become academic affiliates.Some companies offer contracted health care for their employees.National Institutes of Health expands.Funding for health care education.

1952 Joint Commission on Accreditation of Healthcare Organizations (JCAHO) was founded.

1965 Medicaid and Medicare enacted.King-Anderson bill extended Social Security for hospital and nursing home costs (Title 18A).Byrnes program for medical and surgical benefits (Title 18B).AMA version of Kerr-Mills for aged poor (Title 19:Medicaid). Signed by Lyndon B. Johnson in the Truman Library.

1970s Corporate employers and the government begin seeking ways to reduce health-care costs.

1972 Congress created professional standards review organizations (supplanted in 1982 by peer review organizations). The practice of "cherry picking" (eliminating the burden of insuringt seriously ill people) gained momentum.

1973 HMO Act encouraged the creation of HMOs.

1979 National Committee for Quality Assurance (NCQA) formed by managed-care trade associations to try to fend off federal monitoring of health plans.

1980s Employers embrace PPOs and HMOs.

1982 PROs (peer review organizations), one in each state, are authorized to monitor quality in the Medicare program.

1992 The Health Care Financing Administration (HCFA) transformed the PROS into organizations staffed by medical professionals.

1993 The American Association of Retired Persons and other consumer groups form the Consumer Coalition for Quality Health Care.

1996 Quality Improvement System for Managed Care (QISMC) was established to set the standards for Medicare and Medicaid managed-care plans.

Welfare-reform law (the Personal Responsibility and Work Opportunity Reconciliation Act) separated Medicaid eligibility from eligibility for public assistance and limited the duration of welfare benefits (including eligibility for Medicaid).

1997 The AMA established the National Patient Safety Foundation to try to change the attitudes of the public and health professionals in regards to medical error. Health Insurance Portability and Accountability (HIPPA), also known as the Kassebaum-Kennedy act), allows employees who have lost or changed jobs to purchase health insurance without being denied coverage due to medical conditions.

1999 Children's Health Insurance Program provides states with over $24 billion over five years to address the problem of uninsured children.

2000 86% of American workers (and their families) are covered by managed care.

Please contact Dr. Mark T. O'Connell cmoconnell@miami.edu or Dr. Eugene F. Provenzo, Jr. provenzo@miami.eduwith questions or comments. ©Copyright 2000 University of Miami, School of Medicine.  All rights reserved