This issue of the Journal of Ambulatory Care Management (25:3) provides the reader with a sampling of ambulatory issues ranging from risk adjustment of capitation rates for managed care to statistical process control in ambulatory services. The first several articles analyze the details of managed care and their application into a clinical setting.

Peter Welch, formerly with the American Association of Health Plans and now with a managed care organization in Maryland, highlights the controversies associated with risk adjustment of capitation rates. Two commentaries follow. Risk adjustment of capitation rates represents the key obstacle to effective use of managed care (that is, coordinated care) as opposed to managed risk (trying to enroll the healthy and avoiding the sick), the current version of managed care practiced in this country. This article is important right now as the federal government will be deciding this year on how to implement risk adjustment for Medicare Plus Choice.

One of the challenges to managed care is truly providing this type of care. Muller and colleagues report on an apparently successful initiative to integrating the hospital and ambulatory portion of health care for a mostly low-income population.

Klepper puts health reform into a broad context and outlines a current effort which hopefully will have an important impact.

Diagnostic interventions are rapidly expanding in ambulatory care. Kuznets and colleagues analyze many different management aspects of colonoscopy, one of the most commonly performed procedures done in the United States. It will be interesting to see how the frequency of this type of procedure will change over time as some of the newer virtual technology techniques come on line.

Cusack and colleagues follow with an update on the hospital outpatient prospective payment system (OPPS) in the United States. Implementation of OPPS is rocky at best. It is unclear whether OPPS will have a similar impact on health care delivery achieved under inpatient diagnosis-related groups (DRGs). OPPS is much closer to a fee-for-service system with few incentives to examine the care that is provided in the hospital outpatient department and eventually in ambulatory surgery centers.

I continue to be interested in and am committed to international perspectives on ambulatory care. This issue includes an article by Maged Awni Abu-Ramadan, a Palestinian, on his experience with one of the most common segments of ambulatory services- ophthalmology. Weil discusses issues pertaining to multispecialty group practices.

We continue with some regular features, including an article by Raymond G. Carey on improving care using appropriate statistical techniques, a call to arms for health professionals and human rights by Physicians for Human Rights, and Mark Holt brings us the latest from the Republic of Texas.