In less than a decade, managed care has turned the system upside down, from one in which payments tempted doctors to do too much, to a system in which payments tempt them to do too little. It promised to deliver high-quality care while containing costs, but it has only fully delivered on half of that promise. Meanwhile, consumers hear stories that make them wonder whether care has improved. A young mother in California dies because her HMO delayed a referral to a specialist. People look at those sensational cases of patients being denied care.
Consumers have good reason to wonder about the quality of health care.
There's simply no easy way to tell which managed-care organizations can be counted on to do better or worse than any other. But for many years to come, consumers should be prepared for confusion and frustration. Many patients will become more concerned as managed-care plans, squeezed by competition in many markets, try to cut patient services and reduce costs more. Even the nonprofit HMOs, long considered the crusaders for patient-centered health care, are attacked for skimping on care to stay competitive. Such change may make one want to return to the days when doctors, at least in fuzzy, warm memories, resembled kindly Marcus Welby.