Managed Care

Ever since President Obama took office, health care reform as been a leading topic of reform. The rising cost of health care along with many individuals being dropped from their employer-sponsored health insurance has all lead to the high number of individuals who are uninsured today. Once an individual or family looses their employer-sponsored health insurance, it becomes extremely difficult to find another health plan that provides the right amount of coverage for the right price.

In an aritcle I found in the Managed Care Magazine, four individual views are provided regarding the ethics of managed care. One particular question that was posed to internists asking if they would deliberatley manipulate or misrepresent information they give to an insurance company to provide more care to their patients. The results found that 58% would to obtain coverage for a cardiac bypass, 56% would to revascularize a blocked artery in the leg, and 48% would if a patient was denied intravenous pain medication. Another seperate survey found that approximately 39% of physicians said that they had misrepresented information that went to an insurance company to benefit a patient within the past year.

If the physicians alter the information they provide to insurance companies to help the patient, is this still unethical? Many see this as just cost-shifting. The research done on chart-based data is distored by miscoding anyways.

Everyone knows that managed care has made it extremely difficult for patients to receive any type of treatment beyond the bare minimum. If an additional procedure is ordered, many times the managed care company will not cover it, leaving the patient to pay out of pocket for it. Instead of having patients go through all the paper work and trouble associated with receiving additional test, these physicians have taken it upon themselves to find a way for insurance to allow these additional tests that do benefit the health of the patient. Since the ultimate goal of physicians is to improve the health of their patients, these physicians are infact, fulfilling their goal, but at the expense of who ? I personally believe that if practices such as these continue to happen, total reform of our health care system will never be possible. Yes, managed care definitely needs to change the way in which they conduct their services, but physicians also cannot continue to misrepresent information to managed care companies or else the system will fall back into their old habits.