MANAGED CARE: Boston Globe Asks, ‘Has It Failed?’
With premiums "roaring back with double-digit increases" and public cries of "mismanaged care," the Boston Globe asks whether it's "time to pull the plug." Managed care was supposed to "bring about organized health care systems in which doctors and managers would be working hard to improve the quality and cut the costs," says Alain Enthoven, one of the original Jackson Hole Group "fathers of managed care" and a Stanford Business School professor. Enthoven, who "coined the term 'managed competition,' paving the way for managed care as we know it today," believes that managed care has succeeded, but "not nearly as much as I had hoped." The Globe takes a look at the industry's record on cost and quality.
'What Went Wrong?'
True, managed care is responsible for a 1.1% drop in premiums between 1988 and 1994. And according to Princeton University Professor Uwe Reinhardt, managed care is largely deserving of credit for health care being just 14% instead of 19.8% of the GDP for the year 2000, as predicted in 1993 by the Congressional Budget Office. But HMOs are "steeped in red ink" and premiums are on the rise again -- an average of 15% for next year. Most industry experts agree that the cost increases are being driven by the increased variety, cost and utilization of prescription drugs and advanced technology.
In addition to lower costs, managed care promised "better care." While prenatal care, childhood immunizations and cancer screening all have increased, analysts say that HMOs must start "managing" treatment better by making sure patients take necessary medicines and come in for check ups before problems get too advanced. Many patients don't feel they're getting better care, a perception fueled by media attention to care denials and legislative "right to sue" debates. Paul Cleary of the Picker Institute in Boston believes that HMOS have "failed to earn the public's trust," stemming partly from HMOs' method of choosing participating doctors and restricting access to others. "While some doctors are selected on the basis of how well they care for patients, other are chosen -- and rewarded -- for how efficient they are," Cleary said. Enthoven notes that many consumers were "force- marched by employers into managed care plans, further fueling consumer discontent." The article concludes, "In the end, it may be a case of mismanaged expectations. Managed care promised too much and has delivered too little, at least so far, to keep its critics at bay" (Pham, 9/19).