Managed Health Care

4 Jun

I don’t think I like managed health care.

“Managed [health] care is any method of organizing health care providers to achieve the goal of controlling health care costs and managing the quality of care” (Tobin, January 1997).

It strikes me that the medical profession is no longer concerned about getting the patient well but rather managing the illness.  Each entity must get their “pound of flesh” (Shakespeare):

  • the doctors;
  • the physician assistants;
  • the nurse practitioners;
  • the billing networks because physicians, since the Affordable Health Care Act, have generally affiliated with health networks for billing purposes;
  • nurses;
  • technicians;
  • the labs;
  • the pharmacies;
  • the pharmaceutical companies; and
  • the health insurance companies[1].

The system encourages providers to keep patients within the system instead of getting the patient well.   I just don’t understand.  Perhaps the following examples will explain.

  1. An acquaintance had a mastectomy. Before she could be fitted for a prosthesis bra, she needed a prescription from her general practitioner and not the oncologist which, of course, required a visit to the general practitioner.
  2. An acquaintance is diabetic. The family doctor made a referral to a podiatrist because of some recurring foot problems.  The podiatrist recommended some special shoes for diabetics; however, the podiatrist could not write a prescription for the special shoes.  (Why not?  Who knows?) My friend returned to the family doctor for a prescription and referral to another podiatrist who handles the special shoes.
  3. I’ve had both knees replaced. Before the replacements would be approved, there were X-rays, MRIs, and CAT scans.  Anti-inflammatories were prescribed; blood work ordered.  Fluid drained.  Cortisone injected.  Fluid supplements to help lubricate and cushion the knee joint were tried.  Physical therapy ordered. I can’t recall how many appointments there were before the knee replacement was approved, but each and every one required a fee.
  4. I’ve had some reactions to medication. Fortunately, these reactions have just been minor irritants.  Instead of wanting to address the underlying problem, the physician was eager to write another prescription to address the symptoms associated with the drug reactions. Why take two medications when adjusting the strength of the first addresses the problem?
  5. An acquaintance had edema. A hospitalization addressed the condition but not the underlying cause.  After discharge, the problem reoccurred.  Now, there are four or five doctors involved.  They seem to admit that Lasix should have been continued when he was sent home from the hospital.  There seems to be no idea of the underlying cause as each doctor continues to poke, probe, and order tests.

Why don’t doctors work on getting people well instead of just managing the disease or condition?  Oh, I forgot, as they sang in the musical Cabaret “money makes the world go around” (Kirk & Mallinder, 1998).

Just think about it.

References

Kirk, R. H., & Mallinder, S. W. (1998). Money [Sang by L. Minilli, & J. Gray in the musical Cabaret].

Shakespeare. Merchant of Venice.

Tobin, C. (January 1997). What is Managed Health Care? AADE News.

 

[1] These are probably in inverse order since the health insurance companies like to call the tune.

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