25 May 2012

Restoring the sanctity of the patient-physician relationship. Part 6

Posted by Jody under: Wellness .

In most cases, simple human greed isn’t the motivating factor. Fear is. Doctors may limit care because they’re afraid that if they provide more care, or more expensive care, than their medical peers, they may be cut from managed care panels. Since managed care contracts often represent a sizable portion of total practice income to many physicians, doctors may be reluctant to “rock the boat.” This is especially true in heavily managed care-penetrated urban areas, where competition for patients and managed care contracts can be intense. If you’re a country doc out in a rural area, you have less to fear from managed care now, but the experts say this could change dramatically in the near future.

Some health system analysts fear that the unchecked expansion of managed care may alienate physicians, undermine patients’ trust of physicians, and expand the population of patients without healthcare coverage.

“Physicians will be forced to choose between the best interests of their patients and their own economic survival,” warns Dr. Kassirer.

How can this sort of economic climate in the medical profession help to engender trust between patient and physician? Patients expect doctors to advocate on their behalf, to look out for their best medical interests in times of sickness, vulnerability, and need. They need to be able to trust their doctors completely, and know that their medical care is in good hands. Doctors expect to step forward, to help and to heal. They aren’t taught in medical school to withhold care that is medically necessary or advisable.

Under fee-for-service medicine, with its underlying financial incentives to do more to make more money, all medicine was not always necessarily in the best interest of patients. Medical tests and procedures, after all, can have side effects. They can leave a patient worse off than before because of complications or adverse outcomes. Sometimes, less care (instead of more care) is actually better for the patient. That having been said, it’s also true that too little care, or care given too late, can be ill-advised and dangerous. Consumers need to know they are getting the care they actually need — no more and no less. Their physicians are most qualified to find the right balance and make sure they are cared for properly.

Consumers who sign up with an HMO or otherwise trust their health and well-being to an insurance plan may expect that all care will be provided for them, under all circumstances. They must view the situation more realistically. For many healthcare consumers, particularly those whose health plans were selected by highly cost-conscious employers, the free-rolling and romping days of getting all of the care they want, and letting someone else pay for it, are over forever.

People should be more conscious of healthcare costs, and be more responsible for their own health by adopting healthier behaviors and reducing their personal health risks. Few would dispute that. The risk we face in market- driven healthcare, however, is that cost-containment will eclipse quality, and pleasing investors will take precedence over patients.

In the short term at least, managed care will continue to put increasing pressure on doctors and hospitals to keep costs down, driven by employers who are pushing managed care plans to offer greater value for each premium dollar spent. Corporations who are providing health insurance coverage for their employees are always looking for ways to cut costs and shore up the bottom line. The interests of employers in selecting a health plan are not necessarily the same as those of employees and their families.

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