Managing health care

The second largest managed care company in the country, United Healthcare, now will allow physicians to make the final decisions regarding treatments for their patients. United, which covers 14.5 million people, said this stunning policy change was based on the fiscal reality that its review process was costing $108 million a year and still was authorizing 99 percent of the physicians’ requests for care. While the 330,000 physicians who belong to United are now able to make referrals without prior approval, they will recieve “report cards” evaluating their use of services for their patients.

Managed health care companies were the dominant remedy to control skyrocketing health care costs in the last decade. While the sharp increases in health care costs have been reduced, the tactics used by managed care have created anger and bitterness among doctors and patients alike. Doctors have complained about dramatic increases in paperwork, delays in payments and having their treatment decisions overruled by less-educated managed-care representatives who have never seen the patients in question. Patients have had to endure delays or denials of necessary treatments by what the patients believed to be faceless bureaucrats whose only interest was to reduce the managed care company costs. Managed care became synonymous with corporate greed and power, frustrating the healers and brutalizing the sick and injured customers.

One of the unintended side-effects of cost controls in health care has been that many hospitals throughout the country are on fiscal life support. Managed care companies succeeded in culling out many of the high-risk patients, forcing them into federal programs like Medicare. Swamped by red ink, Medicare cut payments to hospitals, forcing cutbacks in staffing and services. Forty-five

million Americans are without health insurance, and the ranks of the uninsured have increased throughout this decade. Our monthly health insurance payments may have stabilized, but our hospitals are in trouble and too many Americans are without coverage.

It is long past time for patients to begin to exercise some responsibility for cost control. A recent Harvard study of several thousand nurses found that women who eat sensibly, dont smoke, exercise regularly and have an occasional alcoholic beverage were 82 percent less likely to suffer heart disease, stroke or heart attacks than women who did not follow these well-know guidelines for healthy living. Healthy people simply require less medical care.

United’s action of leaving doctors with the final authority in treatment is a significant adjustment in the provision of managed care. However, cost-containment is more important now than ever, particularly if we as a nation decide to protect the health of all our citizens. Rather than demonizing managed care, doctors, hospitals and patients must work together with managed care companies to improve our health preservation.