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.

Saturday, April 11 1998

Commentary by
Roger S Case, MD

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


This is the third in a series of commentaries that addresses the subject of the funding of medical care, and what the average citizen (and businesses) can and must do to regain control of his/her 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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So, here we are, a year further along in this movement called "Managed Care" which continues to distance you from your physician when it comes to ‘treatment choice’, the latter of which is becoming more and more the prerogative of the "plans". And the question is "Are you still able to access and receive the care your physician of choice wishes to provide". Or are your choices in access and treatment being dictated by some entity other than your provider? (Is your provider still in business?)

The funding of health care in this state should not be a problem. . . enough premium dollars are paid by the citizens of this state to the various health plans to more than cover for services rendered. But much of that premium dollar never finds its way to the providers of care — the hospitals, clinics, and providers themselves. It goes instead to underwrite the ‘cost of administrating the ‘Plan’s’ programs. This includes the ‘Plan’s overhead. . . facility (ever see a small insurance building), staff, forms, a governing board . . . and the ‘Plan’ must of course make a profit for their stockholders — all of which detracts from funds available for health care, per se.

Much of the health care administered in this state is to Medicare patients or to Medicaid recipients. Payments for services rendered to these patients are considerably less than the amount billed, often less than the cost incurred by the provider who provided that service. Most individuals in this state are not aware that Medicare payments to Washington State practitioners and hospitals are much less than payments for the same service in other states . . . sometimes only one-half to one-third of that paid in other areas of our country. That is why practices are beginning to limit the number of Medicare patients they will accept, and why many practices refuse to provide care for Medicaid recipients. From a business point of view, they lose money on every such patient visit. Are you beginning to get the picture?

So, what happens when the ‘Plans’ begin to adopt the same payment schedules used by Medicare? And would you blame the ‘Plans’ for doing so? The remuneration for providing a service should be the same no matter the funding source, right? Can you guess what is going to happen? If health care funding problems are not solved, the ramifications are serious and we will see:

  • More people frequently changing physicians or health plans.
  • Providers refusing accepting Medicare and/or Medicaid recipients.
  • More people seeking care in hospital emergency rooms.
  • Physicians closing their practices, leaving to practice in other states or retiring early.
  • Longer waits for some types of care or to see certain specialists.
  • Jobs and some communities' tax bases will be threatened.
  • Increased costs for both businesses and their employees

What necessary services do ‘Plans’ bring to the table? Certainly not health care — that is what hospitals and clinics provide. ‘Plans’ distribute funds… and keep a considerable amount for their own ‘business’. So, what are we to do? Everyone needs to be seriously thinking of more innovative ways to fund their health insurance program. Is it time to consider self-insuring? Medical Saving Accounts? A Single Payer Plan for Washington State?

There are numerous ways to address the funding of health care, but each citizen needs to make his/her voice heard on this issue. Talk to your employer, your health care provider, your hospital’s leaders. If we don’t address this issue now, we will most certainly have to address it in the near future.

Roger S Case
, MD, FAAFP, retired Family Practitioner

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