| Waste, Duplication and Ineffective Care: Managed Care 101 in 2010 (Part IV) |
| Tuesday, November 18, 2008 |
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Clearly, the mission of Managed Care involves all parts of the value equation (See Part III of this Series): quality (both technical and as perceived), cost-if not cost-effectiveness and access. As with the proverbial stool, when it is missing a leg, it is unstable. Cost, however, has always been the bane of Managed Care's existence. Therefore, let me quote from Healthcare Economics an important , but gross understatement with the caveat: the ends do not justify the means:
"Peter Orszag, director of the Congressional Budget Office, estimates that 5 percent of the nation's gross domestic product--$700 billion per yea--goes to tests and procedures that do not actually improve health outcomes...The unreasonably high cost of health care in the United States is a deeply entrenched problem that must be attacked at its root."
The report continues: "There is little doubt that much of health care is unnecessary or at least is not worthwhile in the cost-benefit sense. However, how do we fix this problem?" I suggest reading the entire report as it is fundamental for the future health care in this country. Not surprisingly, it speaks to all the same issues as does "Managed Care, its "past, present, and future -- These are the sentinel issues: prospective payment (read: accountability), a centralized authority (read: single payer) and consumer choice (notably balanced with community rating and a purchasing pool that counteracts the issues of adverse selection).
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| Author Bio |
Jeffrey Kaplan
MD, MS
Jeffrey Gene Kaplan, MD, MS is a Board-certified pediatrician. After 30 plus years as a physician executive of health plans, including Corporate Medical Director (1975-1991, Health Services Association and Health Services Medical Corporation in Syracuse, NY), Regional HMO Vice President, Blue Cross and Blue Shield of Western NY, and National V.P. of Utilization Management at Travelers, Dr. Kaplan returned to the sanity of medical practice where, as he says, he is “no longer confused as to who he represents.”
Dr. Kaplan enjoys practicing at the Ezras Choilim Health Center in the Hudson Valley, Nyack Hosp., and the Westchester Medical Center (Valhalla) and teaching at NY Medical College and Pace University. Dr. Kaplan comes to this blog after a successful six years with Managed Care Interface (pub., Medicom Intn’l) to continue addressing inequities created by our broken health care system. |
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