It's been done in a sinister way. When I want to prescribe X drug or X therapy, I put in a request and the patient is turned down. My patient is told that I prescribed a drug that's not covered, so it's my fault. Or a plan will tell the patient that he can't have an MRI scan because he didn't get appropriate documentation from the doctor. It's always made to look like it's the doctor's fault.
Doctors end up spending a lot of time trying to explain and navigate the system.
Managed care has all these unfair and unnecessary obstacles that are put there to prevent access. This makes the African-American community much more vulnerable, because I don't think blacks navigate the system as well as whites do. Blacks may get into a managed care system that quotes quality indicators showing how well they're doing as a system. But they're not monitoring race and ethnicity. Maybe they have 98 percent overall compliance on a given measure, but only 70 percent or 80 percent in the African-American community.