by Trudy Lieberman
Lieberman, a contributing editor of CJR, is Health Policy Editor of Consumer Reports. She is also a member of the board of directors of the National Committee for Quality Assurance and the Medicare Rights Center.

This resource guide was supported by a grant from the robert wood johnson foundation, which is the largest health philanthropy in the united states. the foundation makes grants to increase access to health care, reduce substance abuse, and improve quality of care for the chronically ill and dying. for information and resources, call the rwjf press line at 609-243-5937, or visit the web site at www.rwjf.org

More than 170 million Americans now receive their health care through an HMO or some other managed care organization. The transformation that managed care has brought to American medicine is one of the biggest stories of our time. We journalists have not always told that story well.

Sometimes, in the rush to make our stories titillating and splashy, we in the news business have relied on anecdotes to "prove" that managed care is harmful. Sometimes we have mixed up issues of service and access to care with issues of medical quality and physician competence. Indeed, information about quality of care is elusive, and the word "quality" itself has become the most misused in the managed-care lexicon. Sometimes, in outlining shortcomings in some managed care, we have falsely portrayed as golden the fee-for-service era, forgetting all the warts on that model.

The fault is not entirely journalism's. Many practitioners, bent on protecting their incomes, have tried to use the media to further their cause. Other interests with high stakes in the medical business have tried to turn health care into a commodity, a product that easily can be rated, one that people can choose like a car or a computer if they just have the "right" information. But getting the right information is not that easy.

After covering the subject for nearly a decade, I have concluded that managed care is the quintessential gray area. For all the anecdotes about patients denied care that they needed, there are just as many about people who are happy and have received good, even excellent care. In "good" HMOs, some members have received bad care; in "bad" HMOs, some people have been treated well.

The California Health Rights Hotline found that Medicare beneficiaries who get their care from HMOs are five times as likely to report problems as beneficiaries who get their care from fee-for-service doctors. Yet consider the outcry from beneficiaries when their HMOs withdrew from the Medicare program. Paradoxes like these abound in managed care, and they make our job of distilling the story so darn difficult.

We all know that the U.S. is not returning to unlimited, fee-for-service medicine. The managed-care story is not disappearing. It is dynamic, with new players appearing and old ones recasting their scripts as they look for ways to respond to the changing marketplace. The guide that follows aims to help journalists find out who the key sources are and to cover the new structure in health care, including the business of managed care, the politics it is enmeshed in, and its effects on the health of so many Americans.

Accrediting Organizations

Advocacy and Consumer Organizations

Federal Sources

Education and Research Organizations

Employee Benefits Consultants

Employer Coalitions and Purchasing Groups

Analysts and Researchers

Labor Unions

Medicaid and Medicare

Mental Health and Managed Care

Organizations

Trade and Professional Associations