THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, April 14, 1995 TAG: 9504140003
SECTION: FRONT PAGE: A12 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 57 lines
There is no magic to managed health care. But for the recipients of Medicaid, the government health-care program for the poor, and the state and federal taxpayers who fund it, there is a logic to managed care through health maintenance organizations, or HMOs. They provide each recipient a primary-care physician, who oversees all treatment, which means a healthier patient, which means lower medical costs overall.
Or so Hampton Roads and its HMOs hope to show. As of January 1996, this area will start the pilot program for the state by enrolling its 100,000 Medicaid recipients in private HMOs. The state will pay the HMO a set fee per client per month to cover all care required. The HMO that delivers services efficiently and keeps its clients well makes money.
The HMO that skimps on care makes money, too, so monitoring the quality of care is important too.
No question, money is driving the move to managed care for Medicaid recipients. Growth in Medicaid is the buster of state budgets, including Virginia's. Since 1980, the commonwealth's Medicaid bill has quintupled to $1 billion a year. That kind of pressure is why states turn increasingly to managed care. Of some 34 million Americans eligible for Medicaid, 23 percent are now enrolled in HMOs. That's 63 percent more than just a year ago.
Some states have seen savings from managed-care experiments, some have seen fraud, but all make the point that however rocky the alternate roads, the status quo is untenable. The emergency room, which too often dispenses the only medical care the poor get, is a case of too much too late: too much treatment of non-emergency ailments at too much expense, and too-late treatment that costs the patient in health terms and the taxpayer in money.
One size in anything seldom fits all, including in health care. Medical savings accounts, for example, as alternatives or supplements to HMOs show some success at reducing health costs, especially among the well. But a medical savings account, an amount deposited by an employer and/or employee to be drawn on for health care as needed, can discourage getting care when required in order to rack up cash at the end of the year. Medicaid recipients, a population disproportionately afflicted with chronic and serious disease, need encouragement to get care, not incentive to avoid it.
Medicaid/managed care is not just about providing health services. It's also about breaking unhealthy habits and making a habit of routine medical care. The choices that HMOs deny recipients are choices that middle-class taxpayers who foot their own and Medicaid bills increasingly cannot afford or obtain for themselves. At the same time, Medicaid HMOs more than compensate recipients in opportunities the current system often denies: the opportunity for a regular physician, for preventive care, for continuity of care.
It's certainly worth a try. It's also worth remembering that it's ``managed care,'' not ``miracle cure.''
KEYWORDS: MEDICAID MEDICAL CARE MANAGED CARE by CNB