Many doctors feel the process sometimes restricts their autonomy and calls their professional judgment into question. Managed-care industry officials say saving money is only one part of it. Utilization standards are drawn up by committees of doctors using the best available national data. Conflicts arise when local standards aren't the same as those national standards. Studies show that once communities gain experience with managed care, doctors become far more accepting of it, Mahoney said.
Fowler has a favorite example of that.
Many insurers want him to look for irregularities in patients' colons using a cheaper barium enema rather than a more-accurate colonoscopy. But when the enema's results are inconclusive, the next step usually is a colonoscopy. That means the patient has to go through two tests, and the insurer has to pay for two tests, when the colonoscopy alone would likely have produced good results, he said. Fowler doesn't think the overall quality of health care is declining. But he resists moves to evaluate health care by its effects on groups rather than by its effects on individuals.