Disability and Managed Care: Problems and Opportunities at the End of the Century

Since the passage in 1990 of the Americans with Disabilities Act, society has made considerable strides in improving the quality of life and the productivity of individuals with disabilities. At the same time, however, the American health care system has undergone considerable change, with some unforeseen consequences for those with disabilities. Birenbaum analyzes all of the disability and health policy issues that have emerged from our reliance upon managed care. First, he examines how disability has been defined and redefined in social science and in government regulations. Then, he discusses the major changes in health care over the last decade-in particular, the financial and organizational principles behind managed care. After reviewing the structural advantages and disadvantages of managed care for people with disabilities, he concludes with observations on the future of health care for people with disabilities, particularly in the context of the quality of life and the possible functional outcomes following medical interventions.