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.

Background:

As used here, "case management" refers to the coordination of care from different providers serving the same patient. This often involves the use of a primary care physician, or a nurse, who serves as the coordinator. "Managed care," on the other hand, refers to a health plan that, among other things, uses economic incentives to hold down costs. One of the goals here is to reduce or eliminate services that are deemed ineffective or "unnecessary." Typically, managed-care programmes pay providers on a capitation (per patient) rather than a "fee-for-service" basis and use primary care physicians or other providers as "gatekeepers" to control access to care.

Due to the priority given to profit, HMOs may restrict the duration of patients' visits to the doctor and may deny the patient the treatment that the doctor has recommended.

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.

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