Commentary on Managed Care
(licensed vs non-licensed de facto practice of medicine)



"Managed care is a social experiment involuntarily imposed upon a group of unconsenting subjects... the physician and his patient." Anon.

Monday, 26 April 2010

Commentary by
Roger S Case, MD

(Health Officer, Island County & Commissioner, Whidbey General Hospital)


This is the fourteenth  in a series of commentaries addressing the subject of the funding of (y)our medical care, and what we as wage earners (and businesses) can and must do to regain control of his/her/our healthcare dollar.

Friday, 18 April 1997

  Saturday, 26 April 1997

Saturday, 11 April 1998

Friday, February 15, 2002

Friday, 11 July 2003

Saturday, 7 January 2006

Friday, 10 November 2006

Sunday, 18 March 2007

Wednesday, 13 February 2008

Wednesday, 30 April 2008

Tuesday, 30 December 2008

Monday, 29 June 2009

Sunday, 16 August 2009

Monday, 26 April 2010

Monday, 15 November 2010

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Well, it's here, the Medical Reform to end all our problems ...in our dreams! This reform in its present rendition will indeed 'fundamentally transform' health care in America.

April 26, 2010 Imagine, for a moment, the sound of ringing telephones in physician offices in 2014, the first year most Americans are required to carry health insurance under historic healthcare reform legislation enacted last month. Imagine that. Everyone will be required by our Federal Government to purchase insurance ...as if that will assure everyone access to care! Insurance alone does not assure care. From what pocket are we to draw the needed primary care providers required to address the surge of the 'newly insured' (formerly uninsured) multitudes? Legislation does not provide providers by decree. They must be trained... and willing to enter a field strewn with an unknown future.

The shortage of primary care providers is absolutely scary! In the near term this shortage can only be filled by what we call 'mid-level providers' (soon to be seen as first-level primary care providers), and even there we will experience a shortfall in needed numbers to address the surge in requests for care. Licensed physicians will flee to specialty practice where the remuneration will at least meet the overhead costs to maintain a practice. This will herald a marked change in the provision of health care in America.

Most of this transformation will shake out over the coming 4-5 years during which the stampede to find providers for Medicare and Medicaid patients will be the greatest challenge, and the survival of our smaller hospitals will be at stake at least in the manner in which they are now being operated. Affiliation and/or consolidation with larger facilities will become the norm, and employment of healthcare professionals (physicians and surgeons) will be the only manner in which primary care physicians will continue to survive in the community.

Why is this happening?

People have given up their responsibility to provide for themselves and are turning to "the government" to do for them what they in former times did for themselves. The government is not responsible for your health and health care. You are! "The government" does not produce or provide a thing. It only passes laws and taxes the public to have the funds to pass along to those who provide services. This is terribly inefficient and needlessly interfering in the doctor-patient relationship necessary for personal quality care. Because of our demonstrated proclivity to 'be provided for' we have brought this fiasco upon ourselves... and what are "we" going to do about it?

We are going to get used to a different way of seeking care not necessarily a lower standard of care, but different in where we obtain access to care, and with whom.

In a previous presentation on Managed Care I described how storefront clinics will become the norm with mid-level providers as the front line for access. This is probably a step in the right direction because these nation-wide networks of primary clinic operations will have ready access to uniform electronic medical records (EMRs) wherever they conduct business. Your health information will be available in these nationwide networks. Moreover, safeguards present in EMRs can assure a higher across-the-board standard of quality care. This is good.

The hang-up is in just exactly what care will be made available (can you spell reimbursable?). The time will come when the concept of "cost-effective" will come into consideration... and that takes away one's control over what care you will receive. We'll just have to wait and see how this plays out, won't we.

We are indeed living in interesting times ...in a lot of ways. Stay tuned. Stay well.


Roger S Case
, MD, FAAFP, retired Family Practitioner

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