This professional report is designed to provide insights into the way policy initiatives designed for cost containment impact the relationship between managers and clinicians. Chapter two describes five policies that are currently in effect that change the relations between managers and clinicians. These policies are: 1) the implementation of a prospective payment system, 2) the use of utilization review, 3) the use of a gatekeeper model, 4) the implementation of capitation and 5) the development of integrated delivery systems. Chapter three describes a field study in which a total of seventy-four (combined) clinicians and non-clinicians who work in the current health care environment were interviewed.
Because of the array of relationships in health care, the focus on managers and clinicians does not detract from the importance of the relationship between providers and payers, clinicians and clinicians, or clinicians and patients. In fact, it is a result of these complex relationships that the relationship between managers and clinicians becomes so important.