Check it out. Very interesting.

Important to think about this as future physicians, will we let others walk all over us?


http://home.austin.rr.com/austintxmd/Pages/intro.html

Managed care in and of itself is not a bad idea.

The problem in the US at present is that the past couple of decades have provided consumers with low up front costs, prompting them to overutilize services and drive up spending on the part of their insurers. The need to curb spending is the direct reason why you now see many plans moving to cost sharing models and/or limited coverage models.

Managed care is a way of letting consumers choose a buying group where limited services are covered, giving a decreased risk of group overspending. Remember, what the group spends one year will be paid by the group in the next year's premium cycle.

Managed care is not the enemy. Overspending and overutilization is the enemy, because it leaves insurers and consumers in a position where they cannot afford to pay a decent amount for individual services rendered. The damage is already done in many respects. Managed care has tried to correct the overspending problem and fallen short. It's hard to convince the American public that they are not entitled to every aspect of healthcare and at little to no cost.

Think of me as in insurer with $100 in my piggy bank. You charge me $10 per procedure. You have 8 patients for which the procedure in medically necessary, and 4 who think they need it but really don't. In an ideal world, only the 8 who need it would get the procedure, you would have $80, and I would have $20. But, in a premium insurance world where people expect to get their money out of their insurance dollars, all 12 patients insist on and get the procedure. You can only handle 8 patients, so someone else gets the other 4. I only have $100, so I break even, you get $67 and the other provider gets $33. (Or, maybe I take my $20 and stiff you with $53 and $27.) It sucks, hm? This is an example of what overutilization does to the system. Think about it next time someone asks for something you know they don't need.