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 non-consenting subjects... the physician and his patient." Anon.

Sunday, March 18, 2007

Commentary by
Roger S Case, MD

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


This is the eighth 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



This is number eight in a series begun in April 1997 to focus attention on the changing world of health care in America… and more directly, here on Whidbey Island, Washington.

I call this particular commentary "Stepping Into Our Future Of Local Health Care". In fact, parts of our country are already there. Its name: RETAIL HEALTH CLINIC COMPANIES.

Just what do these harbingers of our future offer us? "Convenience Care", a term coined by the Convenient Care Association established just this past year. Already, more than 20 companies currently operate nearly 280 such clinics in nearly 30 states, and that number is expected to rise to about 400 by the end of 2007. Consumer demand for quick access to care is the driving force behind this move by the large health care associations that are shaping the future of health care in America.

There is much to be gained from this change from the private clinic practice of today. Economy of scale will keep overhead down. Enlisting the services of midlevel providers with physician oversight of clinic operations, nationwide electronic medical record access and system integration (not economically feasible for the privately practicing physician group), and cooperative referral to participating hospitals and/or healthcare systems offer the potential for more accurate record-keeping and improved access to care.

These retail health clinic companies will contract clinic space with participating chain stores for convenient location and immediate access to pharmaceutical needs, negotiate with major health insurance carriers for standard pricing, and participate with university medical training centers for out of house externships/ internships for physicians, physician assistants and registered nurse practitioners. Care providers will all be under contract for their services, relieving them of the responsibilities of conducting a business.

Just where does the public enter this picture? 

By paying your insurance premium to your insurance company, your care will continue to be determined by an activity that has no direct interest in your health beyond the financial aspects of their business (i.e., stockholder return, facility maintenance, and staff / CEO salaries). Is that what you want? Is that really in your best interest? What ever happened to direct payment for services provided? In the coming paradigm shift, if you wish to choose your doctor (now referred to as “health care provider” along with non-physician health care providers), you may find yourselves being unable to make this choice.


We have lost control of what was once a real system of health care where direct payment for services rendered was the norm. Does this mean the quality of care is deteriorating? On the contrary, quality of care is continuing to rise, as are the costs of quality care, and that is the crux of the dilemma. The premium dollar is being squeezed for more and costlier service and the middleman cost must be subtracted, leaving an ever lessening residual for hospital/physician remuneration. So why do we need to accept the middleman costs?

I reiterate my last commentary’s closing statement. This scenario of change must alert everyone that the "non-system" of medical care in our country is in rapid transition necessitated by the economics engendered by the growing numbers of the uninsured, the under-insured, the higher costs of the biologic medicines coming on the scene, and the failure of the premium payer (that’s you and I… and business) to formulate a more efficient and effective system of health care for everyone.

Keep yourselves informed. The evolution in our healthcare will be a life-changing event over the next few years.


Roger S Case
, MD, FAAFP, retired Family Practitioner

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