Managed Care & Preventive Health Care

  • I remember when I was in nursing school and as a young nursing graduate hearing about how wonderful managed care would be for our health care system. Proponents spoke in glorious terms about preventive health care and it made such sense. We would all be incentivized to act in healthy ways so as to prevent health problems from cropping up in the first place.


    When managed care was first launched, we continued to hear a lot of rhetoric along those lines. But somehow over the years, that focus seems to have been lost. Sure, some HMOs are still reimbursing subscribers small amounts for participation in weight loss and quit smoking programs.

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    But I have to say, I don't think prevention is the foundation of any insurance company's coverage policies these days. Instead, I see constantly increasing costs, constantly decreasing quality of care, and incentives for rationing care.


    My 75-year old mother, who has emphysema as well as allergies, had a doctor last year who appeared to be a caring, capable practitioner. However, he inexplicably seemed to give up on her after a hospitalization for a COPD flare and labeled her as terminal. He went so far as to completely dismiss increasingly severe leg pain as not worthy of treatment or even evaluation. What happened?


    She ultimately ended up in the hospital with a spontaneous break of her femur (thigh bone)... in exactly the spot where the pain had been. I can't help wondering if that doctor had not been so busy and had more time to truly focus on the cues of the person, if we might have been able to prevent the femur fracture in my mother, along with months of seesawing health problems that resulted afterward.


    Perhaps this doctor was the exception, but I have observed over the past few years that doctors seem to have less and less time to spend with the patient and often rush in and out without even pausing to truly examine us.


    Prevention? I don't think so. There's no time for it nor does anyone truly seem to care enough to make it happen. If I'm feeling generous, I'll say doctors are trying too hard to stay afloat in today's fractured health care system and they've mostly lost control over even the most basic decisions, with managed care reps second-guessing their every treatment decision and practice management firms mandating overbooking of patients.


    When I still had health insurance, my managed care provider was always trying to get me to switch to older, less costly allergy and asthma medicines, despite the fact that the ones I was taking were keeping me healthy and out of the hospital. It didn't make sense.


    Perhaps the prevention-focused health care system being exalted in the late 70s was idealistic, but I have to believe that if we focused more on preventing illness, it would ultimately save us millions, if not billions, in national health care costs. After all, what about the old adages, "An ounce of prevention is worth a pound of cure..." and "A stitch in time saves nine."?


    It's heartening that all of the remaining presidential candidates for this year's elections have included a focus on preventive health care in their platforms. A recent New England Journal of Medicine article, though, takes issue with the idea that prevention would save health care costs. I don't know that I buy into everything they have to say, but it does underline that this is a hot button issue that is not likely to be resolved easily.

Published On: February 14, 2008