Coordinated agency versus autonomous consumers in health services markets: Managed care and consumer-directed health plans are not the polar opposites that many assume them to be

Despite widespread acceptance of the competitive market model in the U.S. health care system, debate continues regarding the optimal form of competition and the patient-professional relationship. The managed care model envisions organizations that act as the consumer's agent, addressing the challenges that consumers face in the market for health care services. The consumer-directed health plan model envisions autonomous, well-informed, price-conscious consumers shopping among providers unconstrained by organizational affiliations. Although advocates of these two approaches stress their philosophical differences, the realities of the market suggest that both models, as well as hybrids, might be valued by consumers.