THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, February 20, 1996 TAG: 9602200001
SECTION: FRONT PAGE: A10 EDITION: FINAL
TYPE: Opinion
SOURCE: By JUSTIN C. MATUS
LENGTH: Medium: 82 lines
In the past few weeks, the managed-care approach to reining in health-care spending has come under increased scrutiny and attack from a variety of interest groups.
For example, Dr. Robert K. Su (``Managed care, no; free choice, yes,'' Another View, Jan. 23) advocated a new approach described as ``autonomous care.'' His model suggested increased patient choice, greater discretion for physicians and a decided shift from the managed care model to a combination of employer-based self-insurance and an employee health-savings-account mechanism.
A General Assembly committee in Richmond approved a consumer-disclosure bill, opposed by managed-care interests, that ``would require managed-care companies to tell patients whether their doctors are paid bonuses if they limit care or provide few referrals to specialists.''
Women's health advocates are lobbying vigorously to remove the classic ``gatekeeper'' function from managed-care companies by establishing a bill that would give women direct access to gynecologists without a primary-care referral.
These brief examples all point to a growing uneasiness about current managed-care practices and related issues such as patient's choice. While the complaints of these many diverse groups may appear sound and justified, we must also look carefully at the consequences of the managed-care movement that has, in fact, slowed the increase in health-care costs.
One of the complaints against managed care is that these organizations are trying to create a monopoly by becoming the sole owner of a health-care system. Sentara is a health-care system that owns hospitals, clinics, a health-insurance company and has physician employees. This however is vertical integration, not monopolization. Sentara has no monopoly on health care in Hampton Roads, witness its competition from Tidewater Healthcare, Riverside Health System and others. Managed care organizations and health-care systems are simply trying to achieve economies of scale, i.e. greater purchasing power with suppliers or by centralizing support functions such as one marketing department to support several hospitals. Measures like this result in real cost savings and are an inherently good thing.
Another bit of faulty logic often used in the attack on managed care is the assumption that patients are no longer purchasers of their health-care and that the buying is centralized in the nameless, faceless and, of course, heartless bureaucracy of the managed-care company. While the buying of services for the aggregate of patients enrolled in a particular managed-care company is centralized, the patient is still an individual purchaser of the health-care service when he or she elects to participate within a given managed-care company's health plan. Patients move in and out of a wide constellation of different HMO plans, third-party-payer schemes and Champus supplemental policies all the time. When these patients move from plan to plan, they are buying a service. They still have choice .
Finally, there is the perception that managed care equates with low patient satisfaction and even low quality. Yet empirical studies have validated repeatedly that service quality under managed care is comparable to other forms of financing and delivery of health care. Patient satisfaction is subject to many influences beyond any clinical intervention . In terms of patient satisfaction, managed-care organizations could do a much-better job by educating their patients and changing patient expectations. A good first step would be to embrace the spirit and intent of the disclosure legislation before the Virginia Assembly.
Managed-care executives deserve both praise and blame for the state of today's health-care system. They deserve praise for what they have done thus far, especially in terms of controlling costs, increasing access and improving quality. They deserve blame for not doing a better job of continually educating the public about managed care.
If managed-care organizations and their leaders want to continue to compete in the marketplace, they must be responsive to the patient. However, physicians and patients must understand fully that the health-care-policy debate is not an either/or, all-or-nothing, I-win-you-lose proposition. Only through the free exchange of ideas and opinions and through the art of negotiation and compromise by all parties - physicians, patients and administrators - will the health-care system improve. MEMO: Dr. Matus is a practicing health-care executive and health-policy
researcher in Hampton Roads. by CNB