Medicaid, codified under the Title XIX of the Social Security Act, is a joint federal-state program to assist the poor for health and related services in the United States of America. Since 1970s, Medicaid has been faced with two problems: one hand is that it has to enforce its role as a health safety net and the other hand is that it has to adequately respond to the rapidly increasing fiscal burden of the US. To solve the problems, the federal and state governments have conducted various trials, but the most important major strategy that they finally chose was the introduction of Managed Care. After the enactment of the Health Maintenance Organization Act in 1973, Medicaid Managed Care has rapidly increased, and by 2002, more than 58 percent of Medicaid beneficiaries were enrolled in managed care arrangements.
The economic recess in the 1970s and the changes in the political environment including the election victory of Ronald Reagan in 1981 and the dominance of the Republican Party in the congress since 1990s, made the transformation of the US welfare system from the liberal system to the conservative system. The conservative welfare system has changed the welfare including the health care service system into a more privatized one. The rapid increase in number and the commercialization of Medicaid Managed Care since the 1980s were closely linked to these kinds of changes of social policy under the political-economic environment rather than its intrinsic strength as an operational principle.
When we would like to refer to the experiences from the introduction of Medicaid Managed Care, we must place it in the understanding of political context of the social policy in the United States of America. In spite of the limited application of the U´s experiences to the health policies in Korea, some of them, especially the political strategy of the government using Medicaid as an important political vehicle for the health policy, political dynamics that the relationship between the federal and state governments is producing, and various idea and techniques for cost containment and quality improvement will be helpful to plan and implement health policies for the poor in Korea.
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