MANAGED CARE: No ‘Magic Bullet’ for Health Care Woes
As Congress' attention turns to patients' rights and the future of Medicare, "[d]epending on managed care to be the 'magic bullet' ... could be a risky proposition," says Julie Rovner in her CongressDaily HealthMatters column. Analysts who had envisioned a managed care "utopia," in which physicians and hospitals would partner with a single managed care plan, are just now "tak[ing] into account the real world behavior" of providers and consumers. Patients have insisted on keeping their own physicians, Rovner says, and hospitals, "many with dozens or hundreds of empty beds, [have] wanted to draw patients from as large a population as they could." The Center for Studying Health Systems Change (HSC) takes a look at the "real world of health care" in 12 markets around the country to offer some telling insights regarding managed care penetration, Rovner says. The "most striking finding," she says, is that enrollment in HMOs is lagging behind analysts' predictions. For example, in heavily-penetrated Orange County and Boston, only 46% of insured residents are enrolled in an HMO. "A lot of the thinking about how managed care was going to expand are simply not bearing out," said HSC President Paul Ginsburg. Rather than the envisioned vertical integration, in which providers partner with a single plan and patients are steered toward the most appropriate level of care, the market is experiencing "vertical disintegration," he said, noting that "hospitals are selling off health plans they've started, while health plans are divesting themselves of hospitals and doctors practices they've purchased." Capitation has also hit the skids as patients opted for more open networks. In the end, Ginsberg says, "less 'managed' managed care means 'cutting of the ability of managed care to improve quality and limiting its ability to cut costs in the future.'" Rovner concludes that pinning hopes on managed care could be dangerous. "For those debating policy changes at the national level, the message is ... pretty clear," she says (Rovner, 9/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.