Let doctors manage health careWith managed care a pivotal...

the Forum

April 15, 1994

Let doctors manage health care

With managed care a pivotal aspect of the current debate on health care reform, it is time for the public to hear directly from health care professionals what it is like to work in a health care system that is dictated by managed care.

What managed care means to the physician is that we usually have to obtain pre-authorization for expensive medical procedures and contend with gatekeepers or case managers who control access to medical care.

Often we must obtain a second opinion to perform elective surgery,and we must prove that our patients meet criteria for medical necessity based on standards which insurance companies have made.

What it means to our patients is that they may very likely have direct contact with a gatekeeper or case manager.

If the recommendation for an expensive procedure has been made, they can expect their physician has probably discussed their case with a gatekeeper; and should they have to be admitted to a hospital, the chances are very high that their discharge date has been pre-determined by their diagnosis, rather than by their speed of recovery.

We don't argue with the goal of trying to control health care costs. What we question is whether this is the best method.

Although intended to control the high costs of health care, there have been significant problems with managed care interventions. Managed care has not proven to save any money nor improve the quality of medical care.

Furthermore, managed care itself costs significant amounts of money as reviewers' goal is to minimize your use of resources. Although physicians' fees are regulated, there are no regulations on salaries earned by insurance and managed care executives.

As health care professionals, we believe it is important to share with the public the impact these changes have had on the treatment we offer our patients.

As health insurance policies become more complicated and restrictive, less time is spent in direct care with patients and more time is spent either deciphering the insurance coverage or trying to contact case managers.

As our patients have become more knowledgeable about their health insurance benefits, they are now more angry and frustrated with what they perceive as unfair coverage.

Since the insurance company has become a controlling voice in treatment decisions, the relationship between patient and doctor any other health professional) is now tainted with anger and resentment rather than trust and hope.

What changes do we recommend? We would like the objective of controlling medical costs be a shared treatment goal between patient and doctor.

We would like a new concept of managed care, one which allows the patient and doctor to determine the best course of treatment in the most cost-conscious manner.

In this new vision of managed care there would be no outside "manager," insurance companies would return to the role of insuring (not controlling) medical care, and doctors would again be allowed to devote their full time and attention to providing quality medical treatment.

Anne Stoline, M.D.

Wendy Garson


Double standard?

Is it true that the Clintons, Congress and congressional aides will be covered under a different health-care plan than the plan which will cover the American people?

A double standard already exists between Congress and the rest of America. Why allow it to continue as new laws are voted into existence?

Please print the names of any groups working for more equity between government and the ordinary citizen.

I am willing to work to make people aware that our taxes are funding a more generous health plan for elite government employees than we will get ourselves.

Evelyn Karnes

Bel Air

Police reforms will hurt performance

Many of Police Commissioner Thomas C. Frazier's initiatives, particularly his decision to decentralize command, appear solid. However, the benefits of such "good calls" will be totally negated by one "bad call" -- his rotation scheme.

Granted, one must provide upward mobility for the talented and weed out the incompetent. But his method will lower the level of performance to the mediocre, because it precludes the use of the exceptionally talented and experienced.

The blanket replacement of the experienced by the less experienced wastes the taxpayers' investment in the training of competent and experienced officers and risks lives in the process.

This scheme will drive out our best while it makes the city and the commissioner himself vulnerable to lawsuits by crime victims.

The commissioner must be selective. That's the method we used to hire him, and we expect him to run his department accordingly.

lizabeth Derby


Food for thought

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