Executives of managed care companies boast of the great savings and quality care they are bringing to the marketplace. Historically, managed care companies have focused their attention on employers because employers foot the health care bill. However, consumers are becoming more savvy, demanding more control over how health care is delivered and which providers deliver that care.
Managed care organizations (MCOs) say they are dedicated to the best possible health services. Industry observers question whether MCOs are doing enough to satisfy consumers. MCOs have spent all their time with employers, so they don't realize what employees want. For MCOs to succeed in the market, they will have to give more attention to consumer desires, particularly addressing consumer needs for more control over their provider choices.
Patient satisfaction is the new buzz phrase, and employers and MCOs both want to know just how happy consumers are. MCOs are producing a slew of surveys to show how pleased consumers are, and they are marketing these studies to employers. However, two independent studies contradict the managed care industry.
The Robert Wood Johnson Foundation revealed the results of their study, which shows consumers are not satisfied with their health services. This contradicts the industry propaganda. Furthermore, the Commonwealth Foundation states their surveys support the same conclusion of consumer dissatisfaction. Throughout, the MCOs are compared to the fee-for-service programs and they come out second best. Two aspects of managed care were pleasing to enrollees: the reduction of paperwork and no out-of-pocket expenses. But despite these incentives, enrollees want control over their choice of provider and the type of care to be rendered.
The managed care industry spends more on administrative costs -- particularly public relations -- than the traditional indemnity plans; yet, people want freedom to select their care model. The MCOs fail to acknowledge that Americans like their health care providers. Medrisk Inc., a health information provider, states that of consumers who have an established relationship with a provider, only seven percent are willing to switch to another provider, if their own doctor is not a participant in the network to which they now belong. This means that 93 percent would rather fight for their own doctor than switch. Are we as DCs communicating this very important viewpoint to the legislative bodies of our states? Why not? What are we waiting for?
What does this resistance to switch doctors mean? Undoubtedly, the central role of the doctor/patient relationship is incredible and not even financial provocation is powerful enough to distract the patient/doctor trust. Yes, trust is the basis for the doctor/patient contract. Patients believe their doctor is not only a professional, but their friend, their personal advisor, and ultimately their health care guardian who will help steer them safely through the maze of illness, disease, and attendant fears.
Now is the time for the chiropractic profession to focus on the needs of our patients and resist with all our might the financial seduction of the MCOs. Let us not prostitute the sacred doctor/patient bond for short-term personal gain at the expense of professional ethics.
Chiropractic must help make managed care become patient oriented. We must lead the fight for the patient's right to choose their own provider and thus re-engineer MCOs into a service for health delivery and not a cash machine as they presently are. American consumers have property rights to their bodies, and seven out of 10 HMO members are seeking choice. The recent surge in POS plans clearly indicates that money is a far second to an enrollee's personal provider; that a POS plan can satisfy both the MCO and the enrollees.
If managed care is to survive, the MCOs must work on better access to the patient's provider choice, and thus improve the quality of care as well as satisfaction with the care. Chiropractic state organizations must awaken to this challenge. What do you think?
Arnold Cianciulli, BS, DC, MS
Bayonne, New Jersey
