ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Thursday, November 28, 1996 TAG: 9611290001
SECTION: EDITORIAL PAGE: A30 EDITION: HOLIDAY
COLUMN: Talking It Over
TWO NEWS articles in The Roanoke Times (Oct. 29, ``Hospital workers, unions talk'' and Oct. 31, ``Carilion short of staffed beds'') reported alleged concerns of nurses about staffing and the quality of care at Carilion's two Roanoke hospitals.
Is there a message here? I think there is, but the proper message may be escaping many.
Clearly, Carilion is responding to perceived economic forces in the managed-care environment. Clearly, also, nurses are concerned about the care being delivered in this environment. Carilion probably has moved too far and too fast in preparing for these changes, but this isn't the message. The message is:
* The real culprit is the mind-set and pressure that managed care, especially and foremost health maintenance organizations, has created in the heath-care industry - that is, money rules all.
* Cut-rate medicine leads to cut-rate care.
* The type of care to which patients have been accustomed will not be available at any price in a health-care system (hospital) that has accommodated to HMOs, as it will not be capable of providing that level of care.
There must be a better way to control health-care costs than one (HMOs) that prohibits or restricts patient choice, enslaves doctors while endangering the doctor-patient relationships, and produces huge profits for only a few at the top.
Patients, not entrepreneurs or politicians, must insist on control over their health-care decisions and, therefore, the cost of these decisions. If they do, one will not see headlines such as those recently in this newspaper.
- Philip T. Shiner
We agree there are good reasons to be vigilant about the burgeoning presence of managed care in the health marketplace. Money shouldn't rule all. In some cases, quality of care is at risk.
But we still see out-of-control cost increases as a bigger menace than HMOs. If the price of health insurance grows beyond the reach of many more Americans, how will that help anyone?
For all the (often legitimate) criticisms of its bureaucracy, shoddy mistakes, profiteering and occasional indifference to humanity, the managed-care industry does seem to be having a positive effect on costs, while leaving millions satisfied with the quality of care they're receiving.
Sure, in the absence of more comprehensive reform, oversight and accountability are needed. HMOs should be prohibited, for example, from giving physicians financial incentives to withhold needed care, or from ordering doctors not to tell patients about such care. The trust between provider and patient must be protected. And where quality of care is in fact endangered, that needs to be addressed.
But when you say patients "must insist on control over . . . the cost of [health-care] decisions," we're not sure what you mean. Are you saying patients should pay for the cost of these decisions?
- The editors
Yes! In fact, they already are! Employees, i.e. patients, in reality are now paying for their health insurance, which they receive as a benefit in lieu of salary. Patients also pay for deductibles and co-pays. However, the employer does all the negotiating with third-party payers and providers, choosing what health-care options, if any, employees are provided. As control over health care belongs to the payer of the bills, shouldn't the employee, i.e. the real payer, be making these insurance decisions?
However, it appears if patients want control over their health-care choices they must pay more directly for this right. This could perhaps include paying the premiums for the health insurance of their choice as a payroll deduction that must be used for that purpose or through purchasing groups outside their employment or simply as individuals. Patients then who are directly affected by health-care decisions would be the ones exerting control over health costs and inevitably the scope of rationing that will occur as costs are constrained.
The issue is who will be responsible for determining the type and level of health care available to us all. Since altruism is not a characteristic of most successful businesses, who would you want participating with you in decisions about your life and health - the doctor of your choice or your employer and the insurance company of your employer's choice? It is a matter of patients' rights, patients' freedoms, patients' ability to choose and patients' lives!
- P.T.S. Philip T. Shiner, M.D., is a Roanoke cardiologist.
LENGTH: Medium: 87 linesby CNB