In Managed Care as in Life, Small Advances Add Up

Formularies are an established part of the managed care arsenal now, but they are still not universally accepted. Even now, not all HMOs, for example, have formularies, and many formularies are still advisory.

In our cover story, beginning on page 23, Contributing Editor Jean Lawrence writes about the pressures on health plans to control pharmaceutical costs and the pressures on physicians to conform to the corporate line. What made me hopeful was her discussion of various ways in which physicians are moving toward better compliance without more hassle and pain, from just plain philosophical acceptance of the formulary system (with the opportunity to override for medical necessity) to the introduction of simple and sophisticated technological aids.

This incrementalism to me is part of the story of managed care at its best–identifying a cost-control or health care need and finding ways to address it without doing harm.

The term “incremental” pops up on this month’s Q&A feature, an interview with Ron Pollack of Families USA. Pollack addresses the complaint that the Clinton administration is engaged in an incremental (read “back door”) policy of instituting its failed national health care reform. Pollack is not quite a health care insider, but his views on health policy reflect and distill many of the concerns and resentments that purchasers and patients share.

Speaking of patients, as we should never fail to do, if you turn to page 31, you’ll find psychologist Mark Hochhauser’s unconventional look at HMO report cards. Mark doesn’t address their importance to employers, unions, governments and other bulk purchasers of health care, but he argues, and I think persuasively, that they aren’t much help for many consumers.

Acceptance of formularies. Improvement of report cards. These are good increments that can service society, medicine and business well.

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