Problem

Inappropriate managed care regimes

Other Names:
Profit-oriented industrialization of medicine
Corporate intrusion into health care
Nature:

Managed care as typically practised in health maintenance organizations (HMOs) (as opposed to case management, see below) poses a number of dangers to the health care of individuals with disabilities and/or chronic illnesses. Similar managed-care cost-control techniques in traditional health insurance programmes pose the same risks. Essentially, the problems fall into two categories: (1) those related to economic incentives that lead to under-service, and (2) those related to the nature of this group's health-care needs. Modification of managed-care programmes may remove such dangers, but these modifications are unlikely unless policy-makers change their assumptions about and expectations for managed care.

Incidence:

In one American state, 14 HMOs cover 45% of the population of patients, and so doctors now largely depend upon HMOs to obtain patients.

Claim:

Health organizations treat the insurance contract and not the patient. Doctors are being forced to react to the needs of managers, not those of patients.

Counter Claim:

More American doctors previously practised privately and many held patients' health to ransom with unfairly high fees. Doctors deserve to be at the mercy of cost-cutting management, for they failed to set their prices fairly when it was in their power to do so.

Problem Type:
F: Fuzzy exceptional problems
Related UN Sustainable Development Goals:
GOAL 3: Good Health and Well-beingGOAL 8: Decent Work and Economic GrowthGOAL 12: Responsible Consumption and Production
Date of last update
12.12.2017 – 15:00 CET