Managed care is not a bogeyman. Oh sure, there are many faults with managed-care organizations -- decisionmakers who stress profits over the medical needs of patients and intolerable delays in physician payments.
But the old way of practicing medicine also was riddled with problems. It was a disjointed approach to healing, and it was outrageously expensive. The failures of that system were the impetus to the search for a more rational system of care.
Remember, it was just a few years ago that employers and policymakers anguished over their failure to get intransigent medical inflation under control. Yet recent government figures show the job has been largely done: In 1996, the increase in healthcare spending was the smallest in 37 years: 4.4% (or an incredibly small 1.9% on an inflation-adjusted basis). Much of the credit for the reduction belongs to managed care.
In addition, managed-care organizations are at the forefront of developing a more customer-focused healthcare business. Consumers of healthcare are no longer willing to quietly accept a fragmented care system that seems to operate for the convenience of hospitals, physicians and insurers -- in other words, everyone but the patient. Although the new emphasis may feel like a burden to providers, it's the basis of a new health enterprise that focuses on patient empowerment, improved preventive care and the development of better disease-management techniques.
Nobody is suggesting that physicians should sit idly by and let managed-care plans run amok. In fact, we applaud the efforts of physician organizations in Florida, New York and Texas that are aggressively battling flagrant abuses of managed-care organizations in those states. But laying all the blame for healthcare problems at the door of managed care is disingenuous and inappropriate.
Physician executives would do well to consider the way Lee Newcomer, M.D., in our February issue described his former practice as a medical oncologist. The 900 members of the hospital staff where he worked -- he is now medical director of United HealthCare Corp. -- "never formally talked to one another about solving problems. We were just like independent tradesmen going into a factory."
That factory mentality is not a recipe for success. A high-quality healthcare enterprise requires teams of caregivers working in concert under medical leaders who earnestly support the effort to find and nurture those elements of managed care that are superior while working to eliminate its shortcomings.