Genesis of Managed Care

The Healthcare system in the US has for quite sometime now been driven by employer funded programs. In the early 70's the system took a turn. Employers turned to insurance companies to control costs and the ERA of managed care emerged. Medical insurance companies convinced employers by and large that raising deductibles and out of pocket expenses reduced utilization and lowered costs for the employer. While that sounded like a good idea at the time the result has not been good. Higher out of pockets mean less access to care and as a result conditions get worse because they are not detected and treated early. Conditions like heart disease, prenatal care, cancer etc. are easily treated and curable if caught in early stages. The system discouraged up front treatment to save money. As a result people got sicker and many died. Along come Health Maintenance Organizations (HMOs) that give incentives to health care providers to "manage care" delay might be a better word? The HMO system was set up encourage doctors to minimize treatment to save money. Capitation reimbursement models put a much greater financial burden on the doctors and hospitals while slowing down employer’s annual increases and increasing insurance profits. Insurance companies intentionally designed medical programs that steered insureds into HMOs by cutting benefits in traditional and Preferred Provider Organizations (PPO). This was the ERA of a clerk on the end of an 800 number who told you and your doctor what was best for you and your family. It did not matter that they never met you or knew anything about you. Needless to say we are coming to an end of that system. Next.......Consumer Driven Healthcare

Tim Elenz