This creates tension between doctors, who want to prescribe expensive treatments and diagnostic tests, and health care organizations, which want to cut costs. Statistics indicate a growing need for home care aides, registered nurses, physician assistants, nurse practitioners, physical therapists, nontraditional health aides, and also physicians. Not to mention all the technical and administrative jobs that are in high demand as hospitals focus their energies on efficient management and profitability. There were thousands of mergers in 1996 and 1997, and hospital ownership in some cases changed almost daily. Not surprisingly, employer health-insurance plans have been enrolling in record numbers.
Critics contend that cost reduction has diminished the quality of health care.
And the public and congressional backlash against HMO control over doctors' decisions may be having an effect. In late 1999 there are signs that HMOs are returning some medical decisions to doctors. For example, UnitedHealth Group of Minnetonka, Minnesota, stopped the practice of withholding payment for doctors' medical decisions with which it did not agree. Their activity marks a growing trend among the notoriously overworked population of residents. To date, resident unions have had modest goals of limiting work to about 80 hours a week, but as membership increases, so does power.