Correspondence
Managed Care or Mangled Care?
N Engl J Med 1993; 328:890-891March 25, 1993
- Article
To the Editor:
The Clinton administration promises to make managed care the cornerstone of our new health policy. Because all these systems place the burden of managing on the primary care physician, it is important for the public and health planners to understand how the American insurance industry -- in its desire to “manage” costs -- needlessly wastes physicians' time and energy, increases the cost of delivering care, and mangles the continuity of care.
In my urban practice I participate in 29 different managed-care plans, each with its own panel of physicians, consultants, hospitals, and diagnostic facilities. As a result, few citizens in my community now maintain a long-term relationship with a personal physician. Patients constantly change plans and then have to change primary care physicians and specialists. This situation will only get worse as competition among the plans increases. It is also a time-consuming burden to locate the appropriate consultants for each plan. Years ago, the primary care physician was seen as a single practitioner guiding the patient through the complex health care system; now, the blind are leading the blind. It simply is not possible to have personal knowledge of so many specialists in so many panels.
The snarled referral process depletes the physician's energy and drives up administrative costs. It can take hours to accomplish what used to be achieved with a simple note or telephone call to a trusted colleague. I have added one fulltime administrative person whose time is almost entirely devoted to arranging managed-care referrals. The myriad plans, with complexities of primary and secondary billing, have also made my billing extraordinarily expensive and complex. What was once handled by 1 person now requires 2 1/2 employees, an expensive computer system, and expensive maintenance contracts for hardware and software.
We need a system that retains the desirable feature of eliminating economic barriers to care, while encouraging rather than discouraging continuity of care. The primary care physician should have ready access to a consistent network of consultants. Billing should be uniform and directed to a single source (if billing is needed at all).
Michael K. Rees, M.D.
1195 Beacon St., Brookline, MA 02146- Citing Articles (1)
Citing Articles
1
Tony T. C. Ng, Ian P. M. O'Connell, Edmund O. L. Wilkins. (1994) Growth hormone deficiency coupled with hypogonadism in AIDS. Clinical Endocrinology 41:5, 689-694
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