Excellent points made in this article. Curing the illness becomes the priority, not saving money or what is the best use of money. It is survival instinct that exists in all of us.
So does that mean that we need to have an over-seer (such as government) to make the "hard" decisions regarding healthcare. Or should HMO's to be the bad guy? Or are there other alternatives?
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Re:Informed consumers - the absolute truth
Date: 2008/01/16 18:35
By: jrwbsbl
Status: User
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Forum Junior Resident
Posts: 8
We already have overseers--a chaotic collection of them, called insurance companies. That's what precertification is all about. Access to procedures is the sledgehammer wielded to control what an insurance company pays out in benefits.
The problem with this system is twofold. First it truly is chaotic. The appropriateness of services are rarely assessed in a cogent fashion. They are assessed in a haphazard process based upon flying under the radar, the nature of contracts signed with employers--"sorry that's not covered in your contract" (often signed by employers whose human resources people are clueless), and local cost of a procvedure.
Secondly, there is a consistent pattern of simply throwing one roadblock after another in front of PCPs trying to get certification for a procedure. The assumption is that if the procedure is important enough, the PCP will prevail. Even if the procedure is appropriate, if the PCP does not prevail, two procedures prevented from being performed will pay the salary of the low level employee whose job it is to toss up the roadblocks.
Both of these factors are designed to improve an insurance company's bottom line. They are unrelated to quality of care or intelligent, thoughtful evaluation of what represents solid, evidence-based treatment.
In my book, I explain that's why a RIS would be crucial to lowering costs while increasing quality. A RIS would be independent of a need to generate profit, staffed by the best minds and have a perspective whose goal is purely the delivery of highest quality health care at the lowest cost. That would be its only mandate.
It is difficult to serve two masters.
Jeff Waggoner
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