Hassle-Free Health Coverage: Problems Plans Face
Consumer advocates made much during the late 1980s and early 1990s about the harsh treatment HMOs give members. They told stories -- many factual, some exaggerated -- about so-called "drive through deliveries" (women sent home hours after giving birth), assembly-line surgeries and miserly gatekeepers.
One of the legitimate issues raised by this muck-racking: Some plans put business-oriented administrators -- rather than doctors -- in decision-making positions with regard to the delivery of care.
An impersonal approach has been the source of many problems for HMOs in the public mind. So, most of the plans have begun using networks of so-called "individual practitioners." In these individual practice associations (IPAs), you will get your care in a specific physician's office. More than half the people enrolled in HMOs are in IPAs.
At first glance, managed care appears better than a traditional indemnity plan, on average, at getting doctors to follow basic practices that safeguard health. But critics say that oftentimes, the companies don't follow through to make sure the doctors are tackling problems aggressively.
More often than not, managed care has been criticized for compromising the quality of care just to cut costs. One common, highly controversial techniques that managed care has been criticized for is the use of bonuses or incentive pools to reward doctors for not wasting medical resources. And unfortunately, these incentive pools sometimes cause doctors to deny appropriate care.
Some industry experts suggest that what's most unnerving about managed care is that the care isn't necessarily worse than before, but it brings into focus what a highly variable, random approach doctors and managed care companies take toward medicine. In fact, some researchers suggest that there is little evidence that managed care has nudged doctors toward producing the most cost-effective outcomes.
Recently, the federal government has begun to draft laws which will limit the limits -- reducing the discretion HMOs can use in delivery expensive health care services. These proposals answer the outrages raised by consumer advocates...but they may end up destroying the beneficial cost controls that the plans have mastered.
