This is one of the more interesting
discussions about managed care. Medical management is managed care
and needs to be something everyone is aware of how it will affect him
or her. This is a large area of contention between doctors,
hospitals, and the medical insurance industry including Medicare.
Who is right? After reading and researching this on my own, I think
there are valid positions on both sides of managed care. I will say
that hospitals have the least favorable position in their goal of
larger and larger profits. Physicians may have the strongest
positions and the insurance industry has made some very serious and
deadly mistakes. In addition, the health insurance industry has too
often turned away from serious auditing of fraudulent hospital and
physician claims.
The author is well qualified for
writing about the topic, but as a patient with a chronic disease, I
have some experience with managed care (2004 to Dec 2005). I was
constantly battling to remain on insulin, as they wanted me on oral
medications. My first wife was also under a managed care plan (1998
to 2002) which prevented some cancer treatments. So the first error
in the article is that managed care started to disappear in the early
1990's needs to questioned. At least one commenter to the blog
agrees with this. Managed care has continued despite this author’s
position. It may have decreased in volume of managed care, but has
continued to exist.
I can see both sides; however, until
Medicare and the medical insurance industry does their due diligence,
most managed care efforts will continue to be less than effective or
efficient. Hospitals will continue to recode to obtain fees that
should never have been allowed for procedures that never happened and
make makes patients appear on paper as being sicker that they actually
were. Hospitals will continue to do tests on dying patients that are
not warranted, but will probably not be questioned once the patient
dies. Physicians will continue to perform tests for defensive
medicine purposes to prevent lawsuits.
Some of the comments to the blog are
interesting and do point out some areas that are abused by all
concerned. It does raise questions about the reliability of managed
care; however, other issues that managed care has abused in the past
are presented as well. Managed care in the past has been equated
with excessive use of euthanasia when proper patient care would have
added life and even quality of life. This is a reason to oppose
managed care. Under the current healthcare law, it appears that
managed care may be even more reckless.
I am in favor of proper managed care,
but there will need to be changes to the way it is administered and
more thought incorporated into the decision making. In my
perspective as a patient, I can see the rise of a new class of
patient advocates that will be needed to work for the patient to
prevent abuse of managed care. I oppose some of those that are
operating now as termed “ambulance chasers”; however, the new
class of advocates may need to have some legal training and extensive
medical knowledge.
The other requirement that may not be
wanted is complete transparency by all concerned – hospitals,
physicians, and insurance. If managed care is set up as another
entity, then they will need to be transparent as well.
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