This study examines how healthcare managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors and knowledge about ACOs as predictors. Propensity score matching and analysis is used to adjust the state- and regional variations. When the number of perceived benefits is greater than the number of perceived barriers, healthcare managers are more likely to reveal a stronger commitment to develop a strategic plan for ACO adoption. Healthcare managers who perceived their organizations as lacking leadership support or commitment, financial incentives, and legal and regulatory support to ACO adoption were less willing to participate in ACOs in the future. Future research should gather more diverse views from a larger sample size of health professionals regarding ACOs participation. The perspective of healthcare managers should be seriously considered in the adoption of an innovative health care delivery system. The transparency on policy formulation should consider multiple views of healthcare managers.

When Americans voted in November 2008, many had the presidential candidates' positions on health care reform in mind. Health savings accounts, which are high deductible health plans coupled with a tax-protected savings account, are 1 type of consumer-directed health plan (CDHP) that gained strong support from the Bush administration. Despite evidence of the effectiveness of CDHPs in constraining costs in other countries, the Obama health plan contains no mention of their role in future US health reform. This article seeks to provide the reader with a better understanding of how CDHPs can help to improve the use of health resources and reduce national health care expenditures by exploring the history and previous research on several types of consumer-directed plans and by providing a comparative analysis of the use of CDHPs in other countries.

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