Putting Greater Emphasis On Getting Back to Work

I try to be receptive to new ideas. I really do. After several years covering managed care, I've watched quite a few run up the flagpole, only to see them unceremoniously lowered for lack of salutes.

Sometimes I buy in. Later I'm embarrassed because I didn't think the issue through, or mystified that others didn't share my interest and approval. Sneer if you want, but President Clinton's health care reform plan had strong points: competition was promoted, enrollees' (not employers') choice was ensured, fee-for-service was even given a fighting chance. Yes, the plan was a boondoggle, but was the nation well served by the coalition of special interests that dismissed it instead of fixing it?

This month I'm willing to buy into the idea that greater management of workers' comp care (see our cover story, starting on page 31) will hold down disability insurance payouts and return workers to the job quickly. I'm also intrigued by the idea that some workers' comp principles could be applied to group health. But it bothers me that so many of the changes we see in health care are being made in the interests of employers, and only incidentally of enrollees.

It wasn't so long ago that the “primary care gatekeeper” model, which made sense to employers with ballooning health care costs, was new to many physicians. They quickly learned that they not only were required to be more strict about whether to refer than they had been under indemnity financing, but that their income was inversely related to their frequency of referral. But as we see on page 105 of this issue, the primary care physician isn't Superman, however close he may be. Another good idea gone slightly awry in the implementation.

As we evaluate new management techniques in the rush for competitive advantage, we must remember that the enrollee, sometimes quaintly known as the worker or the patient, should be more than a pawn on the corporate chessboard.