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1996-01-01
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MLC Extra
Doctors Prefer Fee-for-Service
This is the third in our series of NewsCenter 5 reports on
"HMO's: Prescription for Concern?"
If you asked Massachusetts doctors what kind of health care they
would choose for themselves, can you guess the answer?
In our exclusive NewsCenter 5/Boston Herald poll, we put that
question to 200 physicians.
And the vast majority, 69 percent said they would prefer the
traditional fee-for-service system over HMO's.
So what is it that troubles doctors so much about managed care?
That's the focus tonight as we continue our series--HMO's:
Prescription for Concern?
Trust, the faith that your doctor will do what is best for you--we
took if for granted once,
Dr. Lawrence Starr (Internist):
"The system is economically driven now. What used to be a system
driven by quality and academic excellence is clearly starting to
be driven by economics."
It is past starting--it's here--last year for-profit HMO's racked up
billions in profits .
Dr. Robert Blendon (Harvard School of Public Health):
"There's no question that in the for profit world, they worry a
lot about the rate of return. You can't have an industry be the
glamorous stock of Wall Street and the charitable institutions
that we want to read about. They can't have Mother Theresa and
Lee Iaccoca at the same time."
Dr. Jerome Kassirer, (Editor, New England Journal of Medicine):
"Medicine really shouldn't be treated like an ordinary market
place in my opinion. Patients are not tooth paste in hotel
rooms. They're people with individual serious problems and they
rely on doctors."
Managed care was born out of the need to control the spiraling
health care costs in this country. So whether doctors are "managed"
by profit or nonprofit companies, patient care is limited to varying
extents. And what galls senior docs is the people deciding those
limits often are MBA's not MD's
Dr. Robert Leffert: (Surgeon, Mass. General Hospital):
"I have had the experience for example of a young man who had a
fracture in his shoulder. That required a prosthetic
replacement. After five years he developed pain and that had to
take care of by another operation...The insurance company said,
you've had your operation. He's stuck."
But younger doctors tend to believe managed care works better for
them and their patients. Especially in the large non-profit
Massachusetts HMO's. Salaried doctors don't need to worry about
budgets and some believe it makes them a better doctor.
Dr. John Ingard (Harvard Community Health Plan):
"You join an organization like this you have the luxury of not
having to run a business. You can devote almost all of your
energy to running your practice and taking care of your
patients. I truly feel that when I see the patient the welfare
of the patient is my paramount concern.""
Natalie:
"Well of course, but do you ever feel constrained by the systems
and the budgets.
Dr. Ingard:
"I can honestly tell you I have been here for 12 years and have
never been reprimanded for ordering a test."
But our poll shows 29 percent of doctors feel pressured in ordering
tests, 44% say they're pressured to release from hospitals too soon.
Dr. William Mason (Surgeon):
"There is tremendous pressure to discharge patients the day of
surgery and I send patients who are in their late 60's who've
had head and neck surgery home the same day."
And as bad as all that seems to many doctors--their colleagues out
West are telling them to brace themselves.
Dr. Lawrence Starr (Internist):
"Doctors in California are telling us: you don't have managed
care, you have managed care light. Wait til you get into
capitation."
Capitation. Doctors are given a budget for each patient and can
sometimes make more money by providing less care.
"It's a budget. You will get paid per patient per month whether
you see them or not. And therefore, the more healthy patients
you have that don't access medical care, the better off
financially you are."
[This report by Natalie Jacobson aired 15-Nov-1995.]
...For further information, contact CURE, 812 Stephen St., Berkeley
Springs, WV 25411. 304-258-LIFE/258-5433 (CUREltd@ix.netcom.com)