The latest blow to managed care?

The Texas attorney general's decision in the Aetna case is the latest in a long string of events that has gutted the fundamentals of managed care. Many in health care think that some or all of these developments — taken together — have stripped health plans of their ability to manage care effectively.

April 2000 — Texas settles lawsuit against Aetna U.S. Healthcare; insurer agrees not to give financial incentives to physicians for limiting care.

November 1999 — United HealthCare says it will stop requiring preauthorization for most treatments.

April 1999 — U.S. Fifth Circuit Court of Appeals says members may take HMOs to state court, upholding Texas's liability law.

April 1999 — California judge upholds $120 million jury verdict against Aetna U.S. Healthcare in David Goodrich case, calling award high but not excessive.

January 1999 — InterStudy Publications reveals that less than 1 percent of HMOs are staff-model. The number of staff-model plans — Paul Ellwood's vision of managed care — is down to eight, after 10 folded in 1998.

1998-1999 — Among workers with employer-sponsored coverage, the share enrolled in HMOs drops, for the first time, in 1998. By 1999, PPOs enroll 43 percent of workers who obtain coverage through employers.

August 1998 — Texas orders Harris Methodist Health Plan to pay $3.4 million to physicians whom the HMO fined for exceeding pharmacy budgets.

September 1997 — Kaiser Permanente, Group Health Cooperative, and HIP Health Plans, plus two consumer groups, call for federal enforcement of 18 patient-protection principles — the impetus for the Patients Bill of Rights.

September 1997 — Texas's first-in-the-nation HMO liability law takes effect.

August 1997 — New Jersey law requires HMOs in the state to offer a point-of-service option. Nationally, point-of-service plans flourish; Barents survey says 92 percent of people with employer-sponsored coverage have option to choose plan that allows choice of out-of-network physician.

January 1997 — Federal law mandating 48-hour hospital stays for mothers and newborns takes effect.

1995 — Maryland, New Jersey, Massachusetts, and North Carolina become first states to pass laws prohibiting “drive-through” deliveries.

1994 — Maryland law is first to designate Ob/Gyns as primary care physicians, starting open-access trend.