MANAGED CARE: In California, Not a Matter of Black and White
In California and across the country, the rise of HMOs has transformed the health care system, altering the traditional ways that physicians practice and patients receive treatment. In an effort to gauge the impact of managed care in Sacramento and across the state, the Sacramento Bee invited a group of seven doctors, health executives and patient advocates to join a roundtable discussion on the state of the industry. The paper published an edited transcript of their discussion. In a follow-up editorial, the newspaper stated that the discussion helped dispel the myth, commonly played out in Washington and on the big screen, that HMOs are merely bottom-line oriented corporations: "[T]he health world looks less cartoonish, more complex and, ultimately, more hopeful," the editorial stated. California's HMOs have transitioned "to a second-generation model" where medical groups, rather than HMOs, make most decisions about their members' medical care. That is good news for Californians, the paper argues, signalling that "the overall health of Californians is improving without legislative intervention."
Topics discussed at the roundtable included the effect of financial incentives on the quality of service, the future of physician groups, and the causes of patients' increasing dissatisfaction with the system. Among the voices heard:
- Dr. David Lehman, a primary care internist with the Sutter Medical Group in Sacramento, on whether the quality of health care has improved since managed care began: "At least in terms of my practice, I think quality is at least as good as it used to be with the understanding there are certain restrictions in who you can use to refer to. So maybe that one particular specialist, I don't really think (he) is quite the best guy in town but apparently he came cheap so we hired him as a specialist, and that is very frustrating. But otherwise, I think quality is quite good."
- Dr. Ernie Bodai, director of breast surgical services at Kaiser Permanente in Sacramento, on a congressional proposal to require health providers to pay for as many hospital days for mastectomy patients as their doctors deem necessary: "From a medical standpoint, it is perfectly safe to discharge 90% of women who have had either a lumpectomy or a mastectomy from the hospital in under 24 hours. ... I do, nonetheless, agree that it should be the physician that makes the decision with the patient as to when they feel comfortable in leaving."
- Steve McDermott, CEO of Hill Physicians Medical Group, on HMOs' profits: "I often want to ask people, how much dividend has Health Net paid, ever, in the whole history of the company? Zero. PacifiCare, HCA, Columbia, these companies don't pay dividends. This isn't Coca Cola."
- Peter Lee, director of the consumer protection program for the L.A.-based Center for Health Care Rights, on what patients want from their health care providers: "[T]he concern they have isn't, does Plan A versus Plan B have a mammography rate that is a little bit better? What they're concerned about is, if they get cancer, do they get to the right specialist? And so where the friction is and where consumers are experiencing the problem is, they look and say, my experience of getting care is very different today than it used to be" (8/8).