Managed Care's Challenge to Stay Vital to Health Care

Article excerpt

Four years ago as our nation was in the process of electing a president, the media was abuzz with stories about the failure of our nation's health care system and the extent to which each party might accomplish major health care reform.

Now, as we anticipate another presidential election, we find that our health care system has indeed undergone an enormous transformation, due not to demands from the political arena but instead to the insistent pushing of the private sector. Rebelling against escalating health care costs, businesses and corporations have steered the country to a health care system in which costs are contained by managed care.

Even after this revolutionary change in the way medical services are delivered and paid for, the media is still full of stories about health care. The target now is managed care and the consumer dissatisfaction resulting from the immense changes it has brought to our health care system. Today there are about 59 million people in the United States enrolled in health maintenance organizations (HMOs), and another 81 million are enrolled in other types of managed care. Seventy-one percent of our country's workforce is covered by some form of managed care agreement, compared with 63 percent the year before. Unquestionably, this rush to managed care has resulted in a decrease in health care inflation, a welcome occurrence. Less well received, however, has been the public's acceptance of certain managed care practices. The media is rife with stories of people frustrated and angry about treatment they did -- or did not -- receive. The dissatisfaction has also been shown over and over in testimony before Congress and state legislatures. "The bloom is off the rose of managed care," is how Jan Ziegler, a Washington-based health care reporter puts it in The State of Health Care in America, a publication of Business and Health Magazine. With the bloom off, lawmakers can see more clearly which thorns need pruning. In 1996, managed care legislation was introduced in almost every state legislature. The American Association of Health Plans says more than 1,000 bills mandating certain HMO policies or practices have been introduced so far this year. …