Managed Healthcare: An Introduction
A great change in health care is sweeping the USA in the form of Managed Care. The new system has been touted by many in the insurance industry as a novelty that has improved American medicine by lowering health care costs and improving its quality by "managing" health care providers. Supporters argue that "managed systems" provide a "managed product" that is
- Better regulated;
- Less expensive than fee for service medicine and
- More socially responsible, providing care for the poor and disadvantaged.
Managed health care has become an increasingly pervasive force in health care today. As more individuals rely on managed health care organizations, the possibility of legal claims for wrongful denials of benefits or substandard provision of care dramatically increases. Yet the law in this area is in change, often limited and at times confusing. It offers limited guidance for either the plaintiff or defense attorney.
Latest articles have raised questions as to whether these assumptions are true. Opponents of the system dispute that managed care is reducing the introduction of new technology, interfering with the physician-patient relationship, worsening outcomes, restricting clinical research, reducing funding for physician training and adversely effecting community based hospitals. Others raise concern about monopolistic trade practices, ruthless business techniques and the subversion of medical ethics. (Hall RCW, 1994; Grumet, 1989; Relman, 1992; Schwartz, 1992; Fox, 1993; Eckholm, 1994; Macklin, 1993; Ingelfinger, 1980; Emanuel, 1995; Clancy, 1995; JAMA, 1995; Welch, 1991; Kassirer, 1994; Iglehart, 1994)
As managed care continues to grow, the relationships among providers, hospitals, physicians and other healthcare professionals are going through change and, in many cases, strain. Emanual and Dobler forcefully argue that managed care is producing a major change in the physician-patient relationship, which has usually been based on what they term the 6 Cs......
