Sunday, May 31, 2009

Managed Care

This last Friday, May 29th was another interesting day at the State Employee Benefits Committee (SEBC). SEBC is the oversight body for the state employees' self-insured health plan. The SEBC has been on an extensive cost cutting mission this year. Towards that end, they are exploring a managed care component for radiology. Supposedly the radiology (MRI, CT, PET, X-Ray)expenses are high for the plan.

The SEBC heard a presentation on Medsolutions, a service that manages radiology use, from Blue Cross/ Blue Shield. The presenting physician said that radiology use for Delaware was above the national average.

Now, this is the point where managed care always go astray. A simple point like a high rate of radiology use is always considered to be over-use or abuse by managed care advocates.

I'm no doctor, in fact I don't even play one on TV, however, I would want to know more before imposing any system that affects access to service. For example, do we have higher rates of cancer in Delaware and thus have more need of CT Scans, MRI, and PET scans? Do we have a high percentage of senior citizens? Since we are a small state is there over-use by one or two providers that could skew the percentages?

The presenting physician several times used hyperbole, saying "We do not need people having MRI for a hangnail". Unfortunately, SEBC is a very closed system and public observers like myself are not allowed to ask spontaneous questions.

If I were allowed to engage, I imagine my dialogue to sound like the following: "Doctor, when you were practicing did you prescribe an MRI for anyone with a hangnail?"
"No? Well do you think so little of your colleagues in the medical profession that you believe they are ordering MRI for hangnails?"

We Americans have a strange attitude about health care use. That attitude applies to health care professional and consumer alike. All of us tend to believe that everyone outside of our immediate family is a hypochondriac and is abusing the system. Stand before any audience and ask all those who go to the doctor on a whim to raise their hands, and no one will. However, everyone in that same audience believes that the world is just full of people taking time off work, waiting in doctor's offices, undergoing painful and humiliating tests, just because they can.

It is a ludicrous myth that we have all been sold by people who would rather take on the health care consumer than the powers behind the health care industry.

Ultimately, if one is talking about the huge type of savings needed for universal health care, there are only two ways to get there. A public, non-profit entity must take responsibility for being either the single provider or the single payer.

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