Managed Care-the kryptonite of Medical practice

04/19/2009 at 5:28 AM Leave a comment

I am not arguing that it was an unmitigated good thing, but once upon a time the power primary care had upon the ordering of tests, admitting patients into hospitals was unrivaled. There was no one looking over my shoulder, or second guessing later, or requiring pre approval.

Certainly that system was unsustainable the way it was. No one holding expenses down was no way to keep going. So the system required some hoops prior to expensive tests. Did not work. We are experts at hoops. It did not even slow us down. So they began inserting preconditions. that did work. Only if you had this or that problem could you get an MRI. In some ways it made my life easier (Heresy! I can hear the mob coming with the tar). It is no longer my responsibility to decide that an MRI is not necesary. Note I did not say ‘cost efficient’ I said unnecessary. It is hard to explain to lay people, or to a jury but there are many instances where this is obvious.

example: a young person ( young= anyone younger than me) with severe back pain. the pain started recently, we know what happened, it is responding to regular medicines. There are two purposes to the MRI:one, in a case where nothing is working to find a reason for the pain. two, to see if there is a surgical repair possible.

So in a situation where the patient is getting better from a recent acute episode, that  no one in their right mind would operate no matter what, the MRI is just window dressing. There may be some who want it for ‘completeness’ sake. A term which meaning I understand but philosophy is more appropriate to accounting, or banking or auto mechanics. 

Sure if the cost of the test was 20 bucks, with no risk, I would not spend this much time arguing either way. But the test is over 1000 dollars. Sometimes it requires contrast.  when the results are not going to change the management, what is the point.


So back to the main theme. Now I can lean on the insurance company. they are the MRI policeman. making sure that a valued resource is not missmanged. Only occasionally with the most regulated insurance do I find myself frustrated. Make that only rarely.

The story is completely different with medication. It sounds the same but the issues are not. you have expensive medicine that they are regulating but in this case instead of regulating an expensive resource and limiting it to appropriate use, they are now simply trying to limit the use of an expensive drug, without regard as to appropriate need, use or alternatives. The equivalent of saying, that yes the MRI is essential but we dont cover that test, perhaps you should try an xray.

The problems with Medical delivery and economics are vast and beyond my family practice mind to even contemplate. But without a severe reduction in the cost of new medicines, new tests, new procedures nothing will change. There is no excuse for a new blood presure medicine to be developed at  a cost to the patient of $100/month, or more. We have medicines that are wonderful, there is no need for more! We have arrived at the shangrila of blood presure treatment. If anything, what we need is a lowering in the cost of some of the current medicines. It is like introducing a new car that does not do anything particularly different but it cost over $100K instead of $30K.

Not a race car or anything, just a regular sedan. They are able to sell it because of marketing and the fact that the consumer is not paying the $100K. I don’t believe for one second that their so called costs of development justify the costs of medicine. 

This has gone too long, I will add another post at some time.


Entry filed under: Uncategorized.

$10,000 for hair? where are your Priorities man? Poor historian alert

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