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Within some managed care systems, physicians who perform more procedures and spend more time with patients than is deemed necessary are penalized or physicians are simply paid based upon their number of patients, rather than the extent of the care they give to patients (Jecker 1998).
Managed care was designed to reduce the tendency of physicians to please patients with 'good' health insurance by allowing them to take drugs (such as brand-name medications or antibiotics) when they were not strictly necessary or have tests for which there was little indication that they would be beneficial for the patient. One of the most controversial aspects of managed care was the insistence that patients obtain referrals for specialists and the need to remain 'in network' for treatments. This was despite the fact that medical opinion might vary widely in terms of the best way to treat an illness. A patient with cancer might receive a recommendation for surgery from one specialist and for radiation from another and the insurance company's policy about what specialist was in 'the plan' and what procedures were deemed medically necessary would prejudice this highly personal decision on the part of the patient.
The hospital where I work, like all medical institutions, has little...
Ideally, I would like a shift to a more comprehensive system of national care, as practiced in other nations such as Canada and the United Kingdom. The levels of bureaucracy created by the managed care system often result in more administrative costs rather than savings, and clearly result in poorer and less comprehensive patient care. Policies often encourage patients not to obtain care because of high copays or fear that procedures will not be covered. This results in higher costs later on when treatment is not provided in a timely fashion. Doctors and nurses should be the ultimate arbitrators of care, not insurance agents.
References
Berwick, D. (2002). Escape fire: Lessons for the future of health care. Retrieved from http://www.commonwealthfund.org/usr_doc/berwick_escapefire_563.pdf
Institute of Medicine of the National Academies. Crossing the quality chasm: The IOM Health
Care Quality Initiative. Retrieved from http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-the-IOM-Health-Care-Quality-Initiative.aspx
Jercker, Nancy. (1997). Ethics in medicine: Managed care. Retrieved from http://depts.washington.edu/bioethx/topics/manag.html
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