Donkeys, Doctors, and Managed Care: A Family Medicine Parable for the Nineties

Johanna Shapiro PhD

The age of managed care is upon us, with greater than 50% penetration of the marketplace predicted in many states (Levit, Cowen, & Lazenby, 1994). This free market development, coming in the wake of the failure of federally directed healthcare reform, is a healthcare revolution that represents both opportunities and dangers for family medicine. Economists, academicians, and public policy analysts have had their say about the implications of managed competition for healthcare (Enthoven, 1995). Perhaps we should also examine wisdom derived from more ancient sources.

In this regard, let us consider an ancient tale about Nasrudin, the wise fool who is the hero of many Sufi legends, which may help us untangle the many complex threads interweaving family medicine and managed care:

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