The Kaiser Building, Portland, Oregon
In the early 70's, the Managed Care Organization model was introduced for the first time to the public as a promise to embody the future of improved care, a truth the public can welcome while covering the reality of managing costs (call a spade a spade: profit maximization.) In 1990, Oregon state adopted this care model but with several decades of using its methods, few health care providers & patients are satisfied with it. Here's why:
1.) Being funneled through a MCO's protocol violates patient ACCESSIBILITY.(1) Labor and Industry MCO's are an extreme example of this. (Up until a year ago, only medical doctors could be certified for overseeing a worker's comp case, and recently chiropractors were added to this.)
a.) Let's say something fell on your big toe and broke it while you were at work. Past the initial visit to ER to reset the bone, you will spend time in a cast, on crutches and wearing a special boot that ruins your natural gait over the next 90+ days (giving you substantial back pain.)
b.) Because MCO doctors are under a normalized pressure to minimize costs, this means the likely-hood of the patient getting a full scope of their injury and what it takes for full restoration is NOT the primary goal. The broken toe patient with a new onset of back problems has very low chances of being referred to a chiropractor and a massage therapist, yet L&I will cover those.
2.) The medical system itself isn't functional yet. According to new research from the Commonwealth Fund, 85% of physicians from the top 10 industrialized nations agree that our health care system doesn't work. (2) And US doctors are the most dissatisfied compared to any other country. Here's an alternative take on why that is:
a.) Medical costs are tripled in the US compared to most countries. The more you profit, the more corporate self interest drives down quality of care and turns your fellow man into a commodity. Translation: We're sustaining enormous emotional conflict over this, no socioeconomic level is exempt and it hurts all of us.
b.) Patients desperate for results ultimately end up in independent alternative care clinics, where an unbiased, low overhead chiropractor or naturopath hears a common thread story all the time: My MD did this, referred me to this, that didn't work, now I'm here.
c.) MD's are limited to a pharmaceutical protocol by their scope of licensing & malpractice insurance, and by default they are often legal scapegoats for side-effects of drugs and pressure to restrict care by insurers. Irony at its worst basically.
Morale of the story: We tried a managed-care-profit-based-health care model, and it didn't work 'Uh-merica. We turned a portion of our own people into medical-malfunction zombies, legal cases and medical bankruptcies soared and we're sorry for it. Let's stop and try the opposite now. Let's advocate a profitless model, close the gap of disconnect between physicians all kinds, and empower patients for their full potential of restoration.
(1) Hall, R. (n.d.). Ethical and Legal Implications of Managed Care. Ethical and Legal Implications of Managed Care. Retrieved June 23, 2014, from http://www.drrichardhall.com/ethical.htm
(2) Kliff, S. (2012, November 15). Six out of every seven doctors agree: Our health-care system doesn’t work. Washington Post. Retrieved June 23, 2014, from http://www.washingtonpost.com/blogs/wonkblog/wp/2012/11/15/six-out-of-every-seven-doctors-agree-our-health-care-system-doesnt-work/
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