Review the sections on “Cost Shifting Hits Private Plans” and “Responding to Cost Shifting” in Chapter 3 in Health Policy Analysis: An Interdisciplinary Approach. These sections discuss a concept of a shift in thinking and practice that is sometimes referred loosely as “breaking the old social contract” that existed in health care before managed care. The social contract concept provides for responsibilities between the government and individuals to be set forth in a negotiated agreement, hence the “social contract”. In this instance, the arena for negotiation and compromise we are concerned with is health care.
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