In response, managed care organizations (MCOs) have loosened or abandoned some of their cost-control strategies, even as states have enacted a spate of consumer protection bills increasing managed care regulation.

Industry advocates say these developments rob managed care of its ability to contain health care costs. But Marc Rodwin, J.D., Ph.D., says that managed care’s lack of accountability essentially worked against it, finally accomplishing what health care reformers failed to do: Stir demands for more government regulation.

Yet government involvement isn’t the only solution. Rodwin believes there’s another option: Give consumers a more direct voice in MCOs.

"Health policy today puts too much credence in the efficacy of markets and too little in the efficacy of consumer voice," Rodwin, a law professor at Boston’s Suffolk University Law School, declares. "Consumer voice could be an important tool for fixing what’s wrong with managed care."

Rodwin has examined in depth the accountability of physicians, health care administrators, and organizations to consumers and payers of health care, as well as to the general public. His work has stressed accountability to consumers, an area he felt was neglected, and focused on the accountability of and within MCOs, because they have become the dominant vehicles shaping health care delivery in this country.

With support from a Robert Wood Johnson Foundation Investigator Award in Health Policy Research, Rodwin conducted an extensive literature review, visited five MCOs and interviewed high-level administrators there, and spoke at length with health care policymakers and advocates.

In his effort to understand and clarify what accountability means in health care, Rodwin also sought to determine how health care accountability could be improved, particularly with respect to MCOs. His solution: Mobilize and give expression to the collective voices of health care consumers. Instead of simply complaining, Rodwin says, consumers should organize and government should support them in their endeavor.