Commentary on Managed Care
Saturday, 26 April 1997
Its time for a change. The individual paying the bill
should be the one directing the show.
Thats the charge I left with you at the close of my recent
commentary on Managed Care. Have you thought any more on the subject? You had better. The
changes facing you today regarding who will see you, how and where you will be seen
even if you will be seen are almost totally in someone elses hands.
Yet you are paying the bill. How does that set with you? Very poorly, I suspect. So what
is all this concern I have with Managed Care? Let me expound. You, too, may be concerned.
Employers have experienced spiraling costs in providing medical
insurance for their employees, due in large part to the increased expectations for the
best medical care available at all times for every insured individual. This means
state-of-the-art service at all times. And that costs dearly. So what has happened on the
way to providing this level of service for everyone? Managed Care has happened,
thats what. But this is a misnomer
it is more appropriately called Managed
Insurance Plans have been enrolling clients into
their programs, promising an array of benefits to entice folks to join their
Plan. They keep costs to a minimum by reducing payments to hospitals and physicians,
setting payments so low that many physicians face losing money by seeing the very patients
who need most to be seen. Plans like to sign up everyone, but the medical system can now
afford to see only the healthier individual, losing money on those requiring frequent
visits. How healthy are you?
This is compounded by the Plans acquiring a panel of
primary care and specialty physicians whom the Plans will reimburse. Other physicians and
providers not on that panel will not receive payment by the Plan for seeing anyone. That
is why you may occasionally be referred to a physician whom you do not know
may even be unknown to your referring physician! Is this good medical care? It may be, but
I dont think so
I dont know. Does your doctor know? Is this what you
want? I certainly dont.
All this happens in the name of managing the cost of providing
care. But I say again, Cost to whom?
The major participants in all this the patient and the
physician are being dictated to by the Managed Care Plans, none of whom have any
stake in the game except to take in premiums and to pay out fixed payments, regardless of
the amount of care required by the patient. And of course they keep a sizable portion of
the premium for the work incurred by managing the financing, all the while absolving
themselves of any risk. And if they dont make enough, they either raise the premium
or reduce payment to the hospital/ provider. Seem fair to you? It doesnt seem so to
There is a better way of doing this, folks. Its time to
really get involved before you find out too late that what you have is not what you
thought you were buying with your medical premiums. Speak with your employers, your
medical providers, the hospital you support, and your family. Decide what it is you really
want, and then demand it. Youre paying the fiddler both financially and
health-wise so you should be calling the tune. Remember, insurance companies are
really in business to earn money for their stockholders
they make profits for their
investors with your premium payments.
You and your health care provider are the only ones truly
involved. Talk to him/her and learn how best to get what you want. Talk to your
employer/union and insist upon what you need. Talk with your elected representatives to
demand an end to the rip-off being run by the Managed Care insurance industry that has
taken themselves right out of the risk business by placing it all upon you and your
providers of care.
Is someones hand in your pocket? Do you hear someone laughing? its the Managed Care industry (i.e., Health Insurance Companies).