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Consumers confront managed-care revolution
September 6, 1996
Web posted at: 11:45 p.m. EDTFrom CNN Correspondent Jeff Levine
WASHINGTON (CNN) -- Managed care has been billed as a powerful dose of medicine for the American health care system's money malaise.
And while experts agree it has helped to keep costs down, the approach has left some consumers angry.
"There has been no uniformity, no regulations that protect all consumers nationwide to make sure that the treatment decisions are not driven by bottom line profitability," said Gail Shearer of the Consumers Union.
With these concerns in mind, President Clinton has just announced a new commission to look into the managed-care industry.
There is little dispute that managed care is a rapidly growing field that is changing the face of American medicine.
As of 1993, there were about 40 million Americans in health maintenance organizations. And that number is increasing by about 2 million a year. As opposed to traditional insurance, these patients must get a doctor's OK before receiving expensive specialty treatment.
Doctors in managed-care plans have financial incentives to provide less care.
"The changes that are taking place are so important and they're moving with so much rapidity, and in some areas patients may be disadvantaged, not having the full access to the range of services that they need," said Dr. Alan Nelson of the American Society of Internal Medicine.
Doctors and patients have complained bitterly of so-called gag clauses that limit communication about treatments not covered by the plan. The president supports a bill that would ban the clauses.
"Too often, many health-care plans are literally gagging their doctors, their nurses and other professionals by stopping them from telling patients about all their treatment options," Clinton said. (10 sec. /119K AIFF or WAV sound)
Lobbyists for the managed-care industry say a legislative fix isn't necessary, but they welcome a Presidential Commission.
"We think that when a spotlight shines on us, that the commission will find much that we do can be used as a model for the rest of health care," said Susan Pisano of the American Association of Health Plans.
Overall, critics said there needs to be more information because health care plans vary so widely.
The commission's report isn't due until fall 1997. But consumer advocates hope the recommendations will help empower patients and regulators to cope with the managed-care revolution.
Related stories:
- Health insurance changes become law - Aug. 21, 1996
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