dr. solomon's dilemma

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COST VS. CARE The battle to achieve a  quality, economically viable health care  system
What Is the Health Consumer's Role in the Health Care Crisis?

CareGroup CEO James Reinertsen believes that the crisis in financing health care must be addressed, at least in part, by the health consumer bearing a greater financial responsibility for his or her own care.
The Wonder Drug of Capitation

Medical economist J.D. Kleimke defends capitation (the payment system which assigns a monthly flat fee to a doctor/medical group/hospital, for taking care of a patient enrolled in a managed health care plan, regardless of the cost of that patient's care.) Kleimke argues that it's appropriate for some financial risk to fall on doctors because they're best able to control spiraling costs and have a vested interest in maintaining their patient's health.
The Game of Risk

During the rise of managed care in the 1990s, the financial risk of patient care became a hot potato--passed back and forth between HMOs and doctors, medical groups and hospitals. Tom Jennings, field producer for "Dr. Solomon's Dilemma," examines the battle that took place in Boston.
Must Good HMOs Go Bad? The Search for Checks and Balances

This New England Journal of Medicine article by Robert Kuttner examines the checks and balances within a market-based health care system that may help prevent professional ethics and patient care from being compromised. For example, theoretically, consumers discipline health plans and providers by choosing among competing plans. And many states have implemented some form of health consumer protection legislation and other regulations. Kuttner concludes, however, that while "in principle, checks and balances are possible to prevent the less scrupulous HMOs from leading a competitive 'race to the bottom,'" in practice, these mechanisms are so complex and create such bureaucratic hurdles that they are unlikely to succeed.
Managed Care and the Morality of the Marketplace

This editorial from the New England Journal of Medicine argues against a fundamental premise of managed care: the idea that medicine should be subject to the same market forces as any other business. Writing in 1995, the author predicted that this "wrongheaded philosophy of health care" would ultimately "alienate physicians, undermine patients' trust of physicians' motives, cripple academic medical centers, handicap the research establishment, and expand the population of patients without health care coverage."
The American Health Care System - Physicians and the Changing Medical Marketplace

Until recently, it was almost universally accepted that commercial managed care had effectively taken control of the medical market, despite the protests of physicians and consumers over what some considered impersonal and draconian cost-cutting measures. In this February 1999 article from the New England Journal of Medicine, Dr. Thomas Bodenheimer argues that perhaps the battle is not entirely over: "In the past two years, a reversal has taken place....The value of HMO stocks has tumbled. . . . The control exercised by managed care over clinical decisions is weakening. . . . Suddenly, the outcome of the contest between physicians and managed-care plans is uncertain. "

For more on the consumer's role in managed care, see the "help for health care consumers" section of our links page.

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