MANAGED CARE: MD Authorization Useless Without Funding
In a Sunday Contra Costa Times op-ed, Michael Ranahan, president of the Alameda-Contra Costa Medical Association (ACCMA), argues that UnitedHealth Group's recent decision to allow physicians to authorize health care services amounts to little in the face of California's low capitation rate and inadequate funding. While the ACCMA praises the health plan for returning medical decision- making to physicians, Ranahan notes that "The result [in Northern CA] is that medical groups...have the authority but inadequate funding to meet patient care needs..." Ranahan cites findings from a PriceWaterhouseCoopers study, commissioned by the California Medical Association, which point to the anemic reimbursement scheme:
- California's health care system received $83 million less per month than the study's average state;
- California capitation rates fell by 35% in the last decade, while the cost of living increased 25%;
- The largest for-profit health plan takes almost 25% off the top for administrative costs and profits before funding any health care services; the largest non-profit HMO uses 5% for administrative costs.