THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, March 18, 1996 TAG: 9603150024
SECTION: FRONT PAGE: A6 EDITION: FINAL
TYPE: Letter
LENGTH: Medium: 51 lines
Justin Matus' ``Health care doesn't need managing; health compromise does'' (Another View, Feb. 20 ) was interesting and insightful. Managed care in Virginia is a convoluted thing, and many people are understandably confused and uneasy.
For those whose goal is to slow medical costs at whatever the cost, managed care in the present form is a good thing. But for those who need to use this system for health care, unease is well-founded. This is especially true of the mental-health aspect of managed care for Medicaid recipients.
The pilot program now in effect in Virginia is structured like this: Administrators for the state Medicaid mental-health services offered managed-care providers about 95 percent of the budget to take over management of all patients. This sounds good; the state saves 5 percent and new cost-saving management is in place.
However, the managed-care companies need to make their costs, which they have assessed at around 40 percent of that contracted price. So now these recipients receive only about half the services we as taxpayers are paying for. And in order for managed-care providers to be able to contain costs, they must provide fewer services. This is done by limiting access through red tape, ``gatekeeping,'' providing incentives for doctors for not referring, etc. One of the most alarming methods for reducing services is cutting the time an acute patient stays in a psychiatric hospital - the standard is three days, whatever the problem or its severity.
Society suffers. Psychotic patients being released before they are stabilized generally end up back in the hospital or jail, frequently after hurting themselves or others, causing property damage, etc. Thus, the ``revolving door'' syndrome that deinstitutionalization made famous haunts us again.
We need to keep managed care out of our Medicaid program. Unfortunately, Medicaid is usually the only insurance someone who is unable to work due to chronic illness can obtain. This being the case, we need to ensure that the dollars we spend for medical and mental-health care for this program stretch as far as possible. There is no doubt that our Medicaid-delivery system in Virginia could be greatly improved, but I am certain that giving away 40 percent to private organizations at the expense of those in need is not the answer.
DAVID DOUGLAS
Norfolk, Feb. 28, 1996 by CNB