Consumers confront managed-care revolution
September 6, 1996
Web posted at: 11:45 p.m. EDT
From 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
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
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