Our Readers Pummel Managed Health Care

The “fax-back” survey printed on page 24 of Managed Care’s February issue was a small, informal and decidedly unscientific enterprise. That’s fortunate for the administrators of HMOs and other managed care organizations, because the survey’s findings, were they to be upheld by a more rigorous polling process, would be troubling indeed.

Perhaps most striking was the response to Question #4, in which readers were asked for their views on a characterization of “today’s managed care” as a “contradiction” because cost competition promotes plan-switching, which negates long-term benefits. The word “today’s” gave a green light to those who might approve of the prepaid health care concept to emphasize nevertheless a negative view of its current application. Still, this was a serious critique, and the fact that more than 80 percent of the Managed Care readers who took the trouble to respond voiced agreement with it should give pause to anyone who claims all is right in the HMO world.

Notable, too, was the near-unanimity with which responding Managed Care readers implicitly trashed the “gag” rules that have been the subject of recent public controversy. Even managed care boosters –those, for example, who gave ringing endorsements to managed care’s outcomes research (Question #1) and to its superiority to key alternatives (Question #5)– joined the 90 percent of respondents who agreed, in Question #6, that patients should be told “if physicians are paid in a way that potentially penalizes them for recommending referrals or procedures.”

Readers apparently voiced that conclusion with an appreciation of its cost. “This is right, but just makes our job that much harder,” scribbled one 40-year-old female physician in the margins of her “fax-back” form. “The system of capitation and full risk needs to be abolished!”

Respondents were asked if they “disagreed strongly,” “disagreed somewhat,” were ” undecided” or had “no opinion,” “agreed somewhat” or “agreed strongly” with the statements quoted. Total respondents = 60

1. “By promoting practice guidelines and outcomes research, managed care organizations offer exciting possibilities for improving the quality of American health care.”

2. “Sometimes a physician is morally justified in exaggerating the seriousness of a patient’s condition to a managed care organization to make sure the patient will receive needed care.”

3. “Capitated payment of physicians is no more wrong than traditional fee-for-service payment; both have their ‘perverse incentives’ that dedication and common sense must overcome.”

4. “Today’s managed care is a contradiction: It’s theoretically based on the medical and financial benefits of preventing disease in the long term, yet the force that drives it, cost-cutting, promotes a level of plan-switching and discontinuity that makes the long term almost irrelevant.”

5. “With all its imperfections, managed care is preferable to full reliance on medical savings accounts, which could encourage people to neglect their health, or a government-run system, which could create a huge new bureaucracy.”

6. “If physicians are paid in a way that potentially penalizes them for recommending referrals or procedures, patients should be aware of this so they can make informed choices.”

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