HEALTH CARE COSTS: Managed Care Was The Right Rx
Under the title, "HMOs Were The Right Rx," this week's U.S. News & World Report reports that Americans' "mounting complaints about HMOs have tended to obscure the genuine gains that have occurred in the managed care era -- for patients, for companies, for the overall economy." "Thanks to managed care," the magazine continues, "Americans have more money in their pockets," may be healthier and more employees are able to afford health benefits. While the managed care industry is guilty of "highly visible indignities and inconveniences," it can list as its "biggest achievement ... controlling runaway costs." According to an American Association of Health Plans-sponsored study released last year by the Lewin Group, managed care was responsible "for between $116 billion and $181 billion in health care savings from 1990 to 1996." And American employers "saved an average of 11% on managed care plans compared with old-style indemnity plans" in 1996. It also appears that "managed care brings better health care results" and better detection of some cancers than traditional fee-for-service plans, the magazine reports. But managed care is in for some rough waters, according to U.S. News, namely, "another round of premium increases." The article concludes, "The rise of managed care was a historically necessary response to a crisis facing the nation's health care system. Coping with the next set of challenges won't be easy. Improving the managed care system is essential; dismantling it is unrealistic. Norman Rockwell's corner doctors is gone for good" (Brink, 3/9 issue). In an accompanying essay, a former HMO administrator "describes the experience that made her leave" the industry (3/9 issue).
Beggars Can't be Choosers
Newsweek columnist Robert Samuelson writes that the managed care "system is chaotic and often inconvenient," but contends "[i]ts largest achievement has been to slow soaring health costs." Samuelson argues that some regulation of health plans is necessary, citing Stanford University health economist Alain Enthoven, "one of the godfathers of managed care," who said, "Managed care could not exist without (regulation). There have to be rules to sustain public confidence." But Samuelson says "there's a rub." He notes that political "backlash could become an overreaction that breeds foolish regulation." Americans should "separate personal peeves from national policy" because most "of the backlash against managed care reflects inconvenience and irritation, not medical failure," he writes. "What's peddled as 'patients' rights' is often 'provider protection'" that may "sound good" but would move the country "in the wrong direction." He concludes, "Americans can't have everything they want: unlimited choice of doctors and treatments, complete insurance for everything and reasonable cost" (3/9 issue). In a separate article, Newsweek's Ellyn Spragins lists several ways to "dodge the blade or at least minimize the pain" when it comes to an "HMO's cost-cutting axe" (3/9 issue).
Cutting Costs ... And Care?
"In the latest wave of health care cost cutting, managed care plans in New Jersey are refusing to pay for a second surgeon in some operations -- even when the primary surgeon and the hospital believe another set of trained hands is needed," the Bergen Record reports. While managed care companies maintain "they are just following national guidelines" when they do not cover assistant surgeons for some operations, New Jersey surgeons contend this practice "lead[s] not only to a loss of income for doctors but to a decline in patient care." Managed care companies say "New Jersey's surgeons are out of step with colleagues elsewhere" when they call in a second doctor to assist during an operation for which national guidelines recommend one doctor. The Record reports that guidelines prepared by Milliman & Robertson, the American College of Surgeons and other surgical groups are most commonly used by managed care companies to determine how many surgeons are necessary at an operation. Surgeons say having a second surgeon attending an operation can save money by cutting down "expensive operating-room time ... by getting the patient out of surgery more quickly." According to the Record, "One top physician described an emerging black market in which patients pay a few hundred dollars to an assisting surgeon, with no bill issued and no insurance claim submitted -- an off-the-books arrangement that is barred by most managed care contracts" (Washburn, 3/2).