|BILL OF HEALTH?
Should the government pass legislation
regulating managed care?
July 21, 1998
in this forum:
Should Congress pass legislation regulating managed care? What responsibility do employers share in the current managed care problem? What are the benefits of managed care? Isn't the HMO debate really a debate over whether health-care should be affordable and accessible for all? Is there a better system for healthcare and if so, what is it? Elizabeth Lubi of Iowa City, IA, asks: We have heard all the negative aspects of managed care, but what about its benefits?
Judy Waxman, director of government affairs at Families USA, responds:
We are not opposed to managed care. We believe that managed care can have beneficial effects. We are concerned, however, that many plans have not fulfilled the promise of managed care. They have gone too far in the direction of "managing" and have forgotten the "caring."
Managed care has its origins in efforts to improve access to health care. At its best, managed care can provide excellent care. In general, managed care does a better job than the traditional fee-for-service system in ensuring that consumers get preventive care and in curbing the overuse of unnecessary tests and procedures. Managed care also has the potential to coordinate care, minimizing conflicts between treatments or prescriptions authorized by a patient's various physicians. It is also generally acknowledged that managed care has succeeded in cutting health care costs, although--as noted above--many believe that some (if not all) managed care plans have gone too far in their drives to bring costs down.
Bill Gradison, president of Health Insurance Association of America, responds:
Thank you for asking. Unfortunately, because of the highly charged political environment currently surrounding managed care, many people do not realize that overall managed care has improved the quality of care provided by doctors hospitals, and other health care providers. Managed care also has lowered health care cost inflation, thereby enabling more and more consumers to afford coverage.
Managed care is responsible for an increasing number of health plans having coveragefor wellness and prevention programs. Because of managed care, consumers now have much more information at their disposal, including innovations such as 24-hour toll-free telephone services offering information about coverage and advice about health care. Because of managed care, health plans are now beginning to provide consumers with important quality of care measures, thereby enabling consumers to better compare how well competing health plans perform when delivering care. Also, many consumers use their managed care coverage with a minimum of paperwork and with very little out-of-pocket expense.
In short, managed care has raised the high quality health care and has brought about accountability to the nation's health care system. And it has put the brakes on health -are cost inflation, which prior to managed care ran anywhere from two to three times the general inflation rate.