Babylonian medicine, managed care and Codex Hammurabi, circa 1700 BC

At the dawn of civilization, about 4,000 years ago, a massive pillar of stone and written clay tablets already prescribed the concepts of managed care for the practice of medicine. Coder Hammurabi established a sliding fee schedule for services, promoted outcome measurements, which if not met, resulted in harsh penalties, required medical records to document diseases and therapies, included prescription benefits, fully explained patient's rights, and marketing and advertising publicized the edicts of the King. Even though the managed care was authoritarian, there were legal actions to insure justice and equity particular to each social class in the kingdom. Tempered by time, the managed care mandates of Coder Hammurabi can still be considered the genesis of the current concepts of managed care.