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MDs Fear Managed Care Equals Lower-Quality Care

MDs Fear Managed Care Equals Lower-Quality Care

NEW YORK--Yogi Berra had the last word at a panel discussion on
health-care reform sponsored by the Medical Society of the State
of New York. Television talk show host Larry King moderated the
discussion and fielded the caustic remarks of doctors, pharmacists,
and medical students who packed a Waldorf-Astoria ballroom to
debate whether quality medical care can be maintained under health-care

No one was optimistic. But what to do? Mr. King quoted the New
York Yankee catcher: "When you come to a fork in the road,
take it." This typically ambiguous Yogi-ism reflected the
audience's evident distress with health-care reform--all forks
seem to lead to managed care.

The land-mine ahead that seemed to most worry those at the meeting
is whether health maintenance organizations (HMOs) and other managed
care plans can provide quality care. "Will physicians be
making the ultimate decisions about treatment or will that be
left to clerks who don't have any medical background," a
medical student in the audience asked, to big applause.

"No HMO would ever consult anybody but a physician to make
a medical decision," panelist Karen Ignagni, president of
Group Health Association of America, a trade association of HMOs,
reassured the student.

Speaking as the only representative of a managed care plan on
the panel, Ms. Ignagni noted that the various forms of managed
care may differ in how they operate, but that in HMOs, medical
decisions are always made by physicians. She added that HMOs have
a track record of providing quality service.

But not everybody was reassured. "May I tell you why I'm
seriously contemplating leaving the practice of medicine,"
said a physician in the audience with some 50 years in practice.
He had received a letter from a managed care plan that began 'Dear
participating provider.'

"You see? I used to be a physician; now I'm a participating
provider," the physician said. "The letter goes on to
say that only one hospital will be allowed to do my patient's
heart operation. You choose a hospital because it has the lowest
incidence of side effects, and they can change it without any
due process."


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