The government's contempt for healthcare's private sector was best summed up by an aide to Rep. Charles Norwood (R-Ga.), who told our Washington bureau that "voluntary quality-control measures don't work. There are always unscrupulous (health) plans out there, and they get away with murder."
Perhaps hospital and healthcare system managers can help change that indignant tone.
Norwood, whose Patient Access to Responsible Care Act already has enough co-sponsors to pass the House, believes managed-care plans lack the decency to treat their customers with fairness and respect. Rather than allow the rights of patients to be victimized by these notorious profiteers, many politicians are anxious to advocate stringent government regulation.
But now it appears the American Hospital Association is willing to join the ranks of those favoring a voluntary private-sector approach to regulation. We would support that stand, especially since the distinction between providers and insurers is blurring into oblivion. Hundreds of hospitals already operate commercial managed-care plans, and others are preparing to enter the Medicare risk-contracting business through provider-sponsored organizations. Furthermore, some of the biggest HMOs are entering into partnerships with the new hospital PSOs.
That doesn't mean consumers don't need safeguards and access to information. Some of the regulatory proposals, such as requiring health plans to cover emergency care and allowing patients to appeal insurer decisions, make good sense. But other protection planks are too costly and onerous. Granting beneficiaries the right to sue health plans over treatment decisions and limiting the authority hospitals would have over workers who report quality problems seem more lawyer-friendly that anything else.
Despite the potential pitfalls of government regulation, the private sector faces an uphill battle convincing consumers that the healthcare industry can police its own. The support of provider groups will help, but by no means will it guarantee a reversal of the managed-care backlash. Frankly, too many people are convinced that healthcare insurers and providers put profits ahead of patients and that managed care sacrifices quality to save money. Notice we lump in providers with the dreaded HMOs. All of you are in this together.
Only an industrywide effort, led by hospitals, health systems and medical groups can change that thinking. The forces of healthcare must converge at a point where managing care, assuming risk and efficiently using resources drive the system. But that doesn't mean it has to be a reckless drive that leaves patients trampled along the wayside.
The natural evolution of the healthcare system has aligned the interests of providers and insurers. So it's a good time to craft a market-based solution that balances patient needs with clinical limitations and economic realities. Overcoming the friction and hostility that exist today will depend on improved customer service and courteous professional behavior. Finally, proper self-regulation will require a system that punishes abuse and spotlights poor performance. Without sharp teeth, voluntary policing programs would pay little more than lip service to the serious subject of accountability in healthcare.