The managed health-care industry in the United States can be considered one of the most revolutionary of its time. In its short, 10-year history, it now covers 75% of the insured American working population, providing an alternative to higher-priced traditional fee-for-service insurance (The Economist, 1998). It may also be one of the most reviled of industries. From its earliest days, it has been criticized for cutting costs to the point of impairing quality. Today, the industry continues to fill American newspaper headlines. It is a major subject of attention, affecting employers, consumers, providers, and investors alike. There is hardly any stakeholder that has not been affected by the radical shifts that have accompanied the founding of this industry.

Over the past months, a new twist on the news has emerged. Starting in a significant way in January 1997 (Stern, 1997) major managed care companies are introducing a new benefit to help attract new customers and appease wary investors: complementary and alternative medicine (CAM). This new association could have important implications for both the managed care and the CAM industries. It begs such questions as Could CAM help improve the reputation and business success of managed care? and Could, in turn, the CAM industry win renewed growth and acceptance in the allopathic medical community given its association with managed care?

Since the trend toward integrating CAM with managed care is in its infancy, we need more time to determine the effects that this relationship will have on its stakeholders. Meanwhile, in order toprovide a critical perspective on the issue, we must look at the available background on the market: (1) industry definition; (2) the significance of this trend; (3) dominant stakeholders and their motivations/reservations; (4) the customer; and (5) the apparent success factors.

Further analysis is necessary to prepare for industry shifts that this integration may engender, such as the types of research that are emphasized, or the level of interest in CAM by the allopathic medical community. Specifically, it would be advantageous to identify and track several key indicators, including trends toward entering or exiting the market, and how different stakeholders are reacting to this new service. This article provides background on the major issues and debates occurring in the lay- and professional press in these areas, and then identifies several key questions to guide a future investigation of the growing dialogue between CAM and managed care. (For more, see American Journal of Chinese Medicine)