Managed CareToday Presents:
Backlash On Managed Care


More and more people are choosing managed health care plans for their insurance coverage. However, are these plans truly providing improved health care, or are they simply padding the pockets of a select few. Managed Health Care today looks at some of the issues affecting the Managed Health Care industry.


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BACKLASH ON MANAGED CARE'S PAYMENT PROCEDURES

According to an article in the May 19th issue of the NY Times, a backlash of criticism is occurring by doctors, nurses, consumers and legislators against managed care’s cost-cutting practices that reward doctors and hospitals for limiting care.

Over the last 18 months, at least 34 states have outlawed or curtailed methods that many health maintenance organizations (HMOs) have used to shorten some types of hospital stays, discipline physicians or keep patients in the dark about the incentives and ground rules of managed care. Some of the changes occurring include the following:

Any Willing Provider legislation: Half a dozen states have required HMOs to include any physician who has the appropriate credentials and agrees to abide by contract terms and conditions;
Capitation: This involves the practice of paying physicians a set amount of money for each health plan member who enrolls as their patient. In some of these arrangements, the costs of certain tests or specialist treatment comes out of the primary physicians fee. A complaint against this arrangement, is that there is incentive to deny medically necessary care. In Oregon, there is evidence of interest in outlawing capitation.
Gag Rules: Many managed care groups have made their panel physicians sign "gag rules" barring them from discussing financial incentives and rules that may affect their care. The managed care groups supposedly would threaten to dismiss doctors if they inform patients about alternative care that might add to costs. At least six states have outlawed these gag rules.
The numbers of people who utilize managed health care for their insurance has steadily been increasing. According to this article, 53 million people have participated in health maintenance organizations, with at least another 70 million participating in other types of managed care plans.

References: New York Times, Sunday May 19, 1996


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