With American health care in turmoil (have you known a time in the last, oh, 40 years when it wasn't?), it's easy to point fingers. It takes more effort to suggest thoughtful remedies. But following through — now that's the hard part.
As this issue of Managed Care came together, it was not lost on us that its content is prescriptive, perhaps even activist. Some oxes will be gored, and some of our readers' ways challenged. We don't necessarily agree or disagree with anything between our covers; rather, we are a forum for ideas that stimulate discussion.
At the root of health care's turmoil is that we have no health care system. System implies connection, but there are few industries as disjointed as health care. Our cover story, by two Milliman USA partners, examines how competing constituencies pushing various agendas are contributing to runaway expenditures. The writers' antidote is one part sacrifice and many parts common sense.
Perhaps nowhere in health care is there a bigger disconnect than in behavioral treatment. Our article on women's mental health highlights the risks in separating mental from medical care, and suggests that by neglecting prevention and risk-screening strategies, health plans have left education up to pharmaceutical manufacturers, whose DTC ads keep medical directors awake at night.
Alan M. Muney, MD, chief medical officer for Oxford Health Plans, adds to our theme, arguing not only that evidence-based medicine should be the standard, but that physicians be held accountable — pecuniarily and through license suspension. If that seems harsh, consider the IOM's 1999 report on medical errors, which fingered practice variation and lack of systems.
The IOM report brought consistent attention to the need for practice improvement, which is the basis for a new bimonthly column on how innovative ideas in this realm are being put into practice. Our maiden column is an overview of concepts to be covered in the months to come.