Re: Another can of worms

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>In a message dated 97-08-18 14:40:50 EDT, (D ROSEN) writes:
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>> What exactly IS managed care?
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Moshe had such a well thought out and clear response, but I'll add my 2 cents worth.
First, PPO's, EPO's POS's, HMO's, etc. all fall under the general umbrella of "managed care", though the term is frequently used as a synonym only for "HMO".
>From a fairly simplistic practical and monetary perspective, I look at it as a provider agreeing to see patients for a discounted fee in exchange for having patients preferentially directed to his/her office. One problem is that if an office runs at 50% overhead (fairly common), a 20% discount off the gross receipts translates to a 40% cut in net income. And the numbers are frequently worse. A 50% discount means the visit barely covers the office overhead. So unless one can accept a significant cut in salary (especially difficult for those having tens of thousands of medical school loans to re-pay), it becomes necessary to see a higher volume of patients just to pay the bills. This can be done by giving shorter visits (not inadequate, just shorter), having ancillary help do things previously done by the provider (telephone calls, history taking, medication/vaccine explanations, etc.), seeing patients less often (but still staying, of course, within acceptable minimum guidelines).
The net result is care which is certainly adequate, but likely not what either the provider or the patient is used to. And studies have never shown that managed care consistently reduces overall medical costs. They're just re-directed somewhere.
Here's food-for-thought: If a non-profit insurance company will give hundred's of millions of dollars to charity in order to obtain government approval to become a for-profit insurance company, there must be a lot of profit to be made. So where do you suppose the costs are being re-directed? (hint - it's not toward lower insurance premiums for consumers or increased reimbursement for providers).

Michael Sachs, M.D.
General Pediatrician