The "managed care" system was originally developed in the late 1920's to provide comprehensive health care to families in the lumber, mining, and railroad industries at a set cost. Enrollees paid a fee to physicians, who then provided care based on an agreement.

One of the most well known models, and one that still exists today, was developed by the Kaiser family during World War II to provide health care to workers in shipyards and steel mills. After World War II, Kaiser Permanente offered its services to the public through a network of hospitals and clinics focused on the idea of providing comprehensive health care, including preventative care, at prices individuals could afford. The managed care model did not expand until the 1971 introduction of President Nixon's Health Maintenance Organization (HMO) legislation, which provided planning and startup funds for the creation of HMOs. HMOs were envisioned as a way to reverse financial incentives that paid physicians and hospitals based on illnesses, rather than promoted the idea of health.

As the system's history suggests, managed care was designed to enable primarily healthy individuals to access a limited number of structured health care benefits in order to deliver health care to the most people at the most affordable prices. Over the years, however, managed care has evolved to develop systems emphasizing disease prevention and health education as additional ways to lower health care cost while improving health.

Today, as historically, the twin challenges of our health-care system are: how to provide the resources that will enable people to maximize their health, well being, and longevity; and how to utilize health-care resources most efficiently. Rather than restricting access to care, the best health care now views patients not as diseased bodies and body parts, but whole persons. Rather than making patients passive recipients of medical treatment, it works with them as active consumers of health care services in the promotion of what is often called health and wellness.

Health and Wellness

Health and wellness is not a static process of examining the functions of organ systems. It addresses the interacting physiological, psychological, social, and environmental processes that make up an individual's life. Health care consumers increasingly expect - and are expected to - manage their own health. The best health care helps them do that. Innovations in our health-care system present opportunities to provide better quality of care for people with disabilities. The challenge for the health care system is to understand the dynamics of providing people-centered services to consumers who are:

* Diverse in terms of type of disability and ethnocultural background; and

* Knowledgeable health-care consumers.

How does the health-care system utilize that knowledge on behalf of both their health and efficient health-care delivery? We can accomplish these objectives only by integrating medical services, community resources, disability-specific health promotion research, and the knowledge and experience of people with disabilities. We must translate this knowledge into resources that can assist health plans in developing services that help people with disabilities live "Healthy with a Disability."