Does the Primary-Care Gatekeeper Control the Costs of Health Care?

IN June 1979, an article in the Journal 1 described a new type of independent practice association (IPA), which was designed to encourage primary-care physicians in private practice to become coordinators and financial managers of medical care for their patients. United Healthcare Corporation, organized by the SAFECO Life Insurance Company, was a first-generation IPA of the primary-care-network type and grew to be the largest of its kind in the United States. In the current climate of government and private-sector interest in health-maintenance organizations and preferred-provider organizations,2 3 4 as well as case management, the SAFECO experience is particularly relevant because of many similarities . . .