Social justice or market justice? The paradoxes of public health partnerships with managed care

Public health is increasingly joining forces with managed care, yet the effect of this partnership on public health nursing (PHN) has received little scrutiny. The feasibility and consequences of a public-private alliance raise questions about whether the mission of public health can be sustained in a managed care system and whether managed care's approaches to health care are conducive to providing population-oriented care. Expanding the links between PHN and private organizations is both problematic and promising. Managed care organizations have much to offer, including coordination of services and comprehensive care. However, they may also restrict coverage and create bureaucratic obstacles to obtaining services. The growth of for-profit health care corporations evokes questions about ways in which concern for communities and populations collide with stockholder interests. The task for PHN is to recognize and to dialogue about these complexities so that nursing's voice can be heard as solutions to these dilemmas are created.