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.

Friday, February 15, 2002

Commentary by
Roger S Case, MD

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

This is the fourth 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



Four years have now passed since my last commentary on the Managed Care issue. Physicians are leaving the state for a more acceptable business environment, and patients across the country are finding it increasingly difficult to find a primary care physician who will accept or enroll them in their practices — especially if they are either a Medicaid Beneficiary or a Medicare patient.

All this is occurring not because there is not enough funding in the health care system in this country, but because the consumers are not in control of their health care dollars, a situation quite unlike that in any other sector of our economy. It is high time for consumers to exercise control of their health care dollars and demand choice among benefits and providers based on quality, service and price… just as in other sectors of our economy. It is time for Defined Contributions from business owners, and Medical Saving Accounts (MSAs) for the individual.

Employers, in looking to reduce the administrative costs and headaches associated with managing health care benefits, can hand to their employee a "defined contribution", permitting the employee to exercise his/her best judgment in shopping for the benefits and providers best suited for themselves. These defined contributions could be in the form of vouchers which could only be deposited into an MSA, assuring that these funds would not be squandered on non-medical spending. Medical assistance funds could be provided in the same form and used in the same manner, ultimately requiring each beneficiary to be accountable for the expenditure of his/her health care funds.

Without imposing this individual accountability for the expenditure of available health care dollars, there will be no curtailing the rising cost of medical and pharmaceutical expenses. America must eventually adopt a consumer-driven health care system and move away from the one-size-fits-all HMO concept which unduly burdens patients and health care providers alike.

Such a system would then place the physician and patient on the same side, both interested in quality service at a price the patient could afford while at the same time reducing the vast administrative overhead now encountered by physician practices. This would create a marketplace that truly compensates physicians and other providers for excellence in performance… reintroducing the quaint business factor of competition for the consumer’s health care dollar based on the range and quality of services provided. This would level the playing field for all competitors… reintroducing "fairness", where no provider is driven from access to patients merely because (s)he isn’t an accepted provider of the ‘Plan’.

To thrive in a consumer-driven environment, physicians must respond to patient needs and demonstrate their value in terms of quality, service, and cost. Patients would shop around for the quality and range of services at a price they could afford. Their health care dollar would go much further than it does under the insurance ‘Plans’ we see today, and both the patient and the physicians’ practices would experience a return to the time-honored physician-patient relationship we all enjoy.

Of course this requires the consumer to be well informed. The move to a consumer-driven health care system will not happen without business leaders, health care providers, and the consumer all working to make this type of service and consumer accountability a reality. This is that ‘better way’ I spoke of in my second commentary in 1997. The consumer has always paid the bill… it's time (s)he begins to direct the show. Don’t you agree?  

Or does anybody care?  

Roger S Case, MD, FAAFP, retired Family Practitioner

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