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Re: Andrea--I hate managed care..(Thanks Dr. Hill)From: D. (anonymous@obgyn.net)Sun, 9 Jan 2000 23:00:53 -0600 (CST)
At Sun, 9 Jan 2000, Gina wrote: Your response to Andrea made me think of a few other points. It is possible that doctors in your area function under a capitated plan. Under capitation an HMO forces the doctor to accept a "flat fee" for each covered life, regardless of how often that person uses the doctor. Thus, if someone gets really sick, he or she may indeed cost the primary doctor money from his or her pocket. Capitation is *supposed* to work by averaging the healthy with the sick, and by encouraging the doctor to keep patients healthy. In real life, however, this is a ridiculous because regardless of how hard your doctor tries, she or he cannot possibly prevent most illnesses. In areas where there are high illnes rates, it can easily become so bad that the doctor is left deciding "should I refer this nice lady to an expensive specialist, who I will have to pay for, or pay my nurses this month?" Obviously I strongly disagree with this type of medical care. With regards to prescriptions, doctors do not get kickbacks for prescribing medications. There is no benefit to me when I prescribe meds. In fact, writing hundreds of prescriptions a week takes time, so it would probably be easier for me if none of my patients needed prescriptions! However, HMOs keep close track of Rx utilization, and may drop a doctor from their plan if he or she uses the most expensive type of medication. Again, this is to motivate the patient and doctor to use equally effective but less expensive medications. In real life it often puts the doctor and patient at odds. The patient is standing in front of the doctor, not a nameless, faceless HMO executive, so she is more apt to become angry at her doctor when she wants a particular medication. There are a lot of problems with HMOs, although some are clearly better than others. Many people do not realize that they have the potential to force change. Write a formal complaint to your human resources department. Write your congressperson. For severe problems, contact the local media. In the meantime, good luck with everything. As a final note to Andrea, I agree that you should have been contacted by the doctor's office. It is a very busy time of year with the flu outbreak, but you have experienced a long delay. Downsizing has hurt the customer service at most doctor's offices, but this seems excessive. Best wishes,
-- David Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency http://home.mpinet.net/dahmd
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