Managed Care Gives Many a Quality Option
As an industry, managed care seems to be constantly in the line of fire. Having worked in that industry for more than 10 years, I guess I should be used to scrutiny by now. However, I still find myself frustrated by the negative emphasis placed on managed care.
Although the system may not be perfect, it has provided millions of people with affordable, accessible and high-quality health care, and it will continue to do so.
During my seven years as a representative of a major managed care plan and my three years as a representative of Buenaventura Medical Group, I have been approached time and again by patients wishing to express their gratitude for the care they have received within a managed care setting.
I remember a young man telling me through tears how thankful he and his wife were for the care their premature twins received in a neonatal intensive care unit. The twins spent more than three months in the neonatal unit, and the couple did not have to pay one cent for the care their babies received. Thanks to this care, the twins were strong and healthy. Their parents could not say enough good things about the services provided by their managed care plan and physicians.
These stories are the norm. This is the type of care that happens every day in managed care.
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There seems to be an irrational longing for the “good old days” of fee-for-service medical care. Yet when you review the reality of traditional fee-for-service coverage, it isn’t all that appealing.
Traditional insurance was characterized by high deductibles, a serious lack of coverage for preventive care and expensive premiums that were increasing in the double digits every year. Most traditional plans required the patient to pay deductibles ranging from $200 to $500 before any expenses were covered. I can’t think of a bigger disincentive to an individual contemplating seeing a physician for routine medical care.
Most of these plans did not cover preventive services such as physical exams, pap smears, mammograms and well-baby or child care. These expenses had to be paid by the patient and, in most cases, could not be applied to the annual deductible.
All these limitations, yet the premiums were completely out of control. Is it any wonder that the public was eager for an alternative that offered easy, affordable access to routine care, comprehensive preventive care and reduced premiums?
Managed care has been shown in numerous studies to provide high-quality care for most people.
An October 1994 issue of the American Journal of Public Health cited a study showing that Medicare HMO patients received diagnoses earlier than their non-HMO counterparts for melanomas, breast cancer, cervical cancer and colon cancer. A study of 100,000 appendicitis patients published in the August 1994 edition of the New England Journal of Medicine reported that HMO patients were 20% less likely to suffer a ruptured appendix than were patients on traditional fee-for-service plans. And a thorough analysis of clinical literature from 1980 to 1994 reported in the May 1994 Journal of the American Medical Assn. found that HMOs provided better or equal results in 14 of 17 quality measures when compared to traditional fee-for-service plans.
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In addition to quality of care studies such as these, numerous consumer satisfaction surveys have shown that most people are very satisfied with their managed care plan. Why are studies like these never referenced in articles that analyze managed care?
As for Buenaventura Medical Group, I am extremely proud to represent this fine organization. It is a privilege to work with a group of highly skilled physicians who share such a deep commitment to providing appropriate, high-quality medical care to their patients.
Since the group was established in 1950, that commitment to patient care has never changed and it will never change. This longevity, the credentials and professionalism of our physicians and the loyalty of our satisfied patients say more about the Buenaventura Medical Group than I ever could.
