HMO DEBATE TO CONTINUE

As in every other state, managed-care health organizations, which last year took in $1 billion and cover more than one million Missourians, are coming to Missouri's health-care delivery system in a big way. Although the thinly populated northern and southern counties have too few physicians to be in the vanguard of managed care, health maintenance organizations have arrived in the state's three largest cities and in central Missouri. Further, the Missouri Consolidated Health Care Plan, which insures thousands of state employees, has moved most state workers from fee-for-service to HMOs. Also, Gov. Mel Carnahan's administration has moved much of the state's Medicaid population to managed care. Savings in the millions of dollars are claimed due to both these moves by the state.

Many health care providers are warning that managed care is no panacea to all that ails our health-care delivery system. Few could dispute this. Questions remain about the quality of care to be delivered, as well as the vital freedom of choice so cherished by the vast majority of Americans. Still, there can be no doubt that what is driving the move to managed care is the desperate need for businesses to gain some measure of control of their health-care costs. Look for managed care to continue its steady growth and for the debate over its merits and demerits to continue as well.