Managed Health Care anyone?

Ground&Pound · 11-27-2007, 09:30 AM

Study sees rise in imaging exams for pregnant women

http://news.yahoo.com/s/nm/20071127/...nancy_study_dc

CT scans for fetuses rising 25% each year.

Are doctors just being more cautious or are they lining their pockets with expensive and unnecessary tests?

Spider · 11-27-2007, 09:47 AM

From the cited article:

A patient being recommended for a test like this should talk to their doctor to find out if there are any alternative tests or if there is any harm waiting," Lazarus said in an interview.

"But if one of these tests is needed, we would not discourage any patients from undergoing one, because making a diagnosis could also be life-saving."

Right. So what's the problem?

therick · 11-27-2007, 09:50 AM

At least one doctor that I work with does a lot of extra tests in the ER simply because he's scared to death of a malpractice suit. With everyone so willing bring legal action for anything and everything, and with malpractice insurance premiums rising all of the time as a result, it's hard to blame a doctor from using any and all means available to get a complete picture of what's going on with the patient.
Are some of those test beyond what is needed? Yes, but if a doctor misses something that could have been found on a CT, you can bet an attorney will use that information if the parents decide to bring legal action for something.

Spider · 11-27-2007, 10:06 AM

Originally Posted by therick

At least one doctor that I work with does a lot of extra tests in the ER simply because he's scared to death of a malpractice suit. With everyone so willing bring legal action for anything and everything, and with malpractice insurance premiums rising all of the time as a result, it's hard to blame a doctor from using any and all means available to get a complete picture of what's going on with the patient.
Are some of those test beyond what is needed? Yes, but if a doctor misses something that could have been found on a CT, you can bet an attorney will use that information if the parents decide to bring legal action for something.

Good point. Doctors practicing "defensive medicine" certainly contributes to rising medical costs. Efforts to discourage frivolous suits or place limits on malpractice awards are always met with opposition.

Ground&Pound · 11-27-2007, 10:48 AM

[quote=Spider;24352]From the cited article:

A patient being recommended for a test like this should talk to their doctor to find out if there are any alternative tests or if there is any harm waiting," Lazarus said in an interview.

"But if one of these tests is needed, we would not discourage any patients from undergoing one, because making a diagnosis could also be life-saving."

That's they way it "should" work if the patient is well informed and willing to question the doctors decision.

----

How it is that for-profit health plans that manage government health programs make money?

Is the government that bad at managing their own programs or are the health plans easing unnecessary spending?

I'm a bit undecided on the issue and appreciate everyone's input.

Spider · 11-27-2007, 11:27 AM

Originally Posted by Ground&Pound

How it is that for-profit health plans that manage government health programs make money?

Is the government that bad at managing their own programs or are the health plans easing unnecessary spending?

I'm a bit undecided on the issue and appreciate everyone's input.

For-profit health care programs are privately run companies that exist only to make money. Heathcare, to them, is simply a commodity that must be bought cheaply (pay the doctors less and authorize fewer expensive procedures) and sold for a profit (high premiums). The less healthcare they provide, the more money they get to keep, so it is in their best interest to deny benefits and disallow procedures whenever they can get away with it. If the government (or anyone) could run a non-profit healthcare program, which would maximize benefits while controlling abuses, everyone except the insurance industry would benefit.

Ground&Pound · 11-27-2007, 12:01 PM

So our two choices are greedy capitalistic private companies or inept and corrupt government agencies.

Sounds like a microcosm of the modern world.

matclone · 11-27-2007, 12:33 PM

You haven't established that private cos. are greedy capitalists, or that doctors are intent on lining their pockets, or that government agencies are corrupt or inept. Also, while CT scans may add to the cost of healthcare (we have to weigh it against the cost of undiagnosed fetal problems), is the cost significant?

Ground&Pound · 11-27-2007, 12:40 PM

I was exaggerating for the sake of the discussion.

What are your views on managed heath care, Matclone?

matclone · 11-27-2007, 12:51 PM

Managed care is an health care industry (read: insurance cos.) designed model that is supposed to hold down costs. Part of the idea (which I agree with) holds that costs are better controlled when patients have ready access to routine care--thereby avoiding very costly untreated illnesses. The $10 co-pay, for example, derives from this.

Because the model is dollar driven (and assumes the participation and profits of the middle man), it doesn't take into account the larger health care picture from a public perspective.

I trust most doctors make decisions with the health care of their patient as the primary concern. I trust most patients are at the doctor's office because of real concerns over their health. I don't assume gov't is corrupt or inefficient.

Managed Health Care anyone?

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