|
|
|
|
|
|
||
|
Advancing Quality of Care at the End of Life A Hippocratic Oath for Our Time Current & Choice: "Physician, Heal Thy Sisters" Reporter Staff: Rachel Muir, Managing Editor |
|
A Word From The President:Lessons from Managed Care
To do so, a clear distinction must be made between managed care “theory” and “practices.” On the theoretical level, managed care calls for the prospective, systematic, coordinated, and evidence-based management of the health and health care needs of patients, families, and communities. At this level, managed care’s impact is altogether positive, having opened our eyes to many features we would desire to see in the ideal health care system. Unfortunately, what we’ve seen of managed care to date is a far cry from the theoretical ideal. Indeed, in practice, managed care has proven largely an economic instrument for controlling costs. But even in this guise, managed care has taught us some important lessons. For example, through practices introduced by managed care, we now know that the systematic use of clinical guidelines can lessen the wide variations that exist in conventional practice, curtail unneeded services, and constrain health care costs — all without necessarily compromising quality. Managed care practices have also called much needed attention to major shortcomings in our current model of health care delivery, including our archaic, paper-bound medical records and our fragmented financing system that frustrate attempts to implement needed reforms. Similarly, in the realm of medical education, fairness requires that we acknowledge the positive as well as the negative influences that managed care has had on the way medicine is taught. With respect to the content of medical education, the theoretical construct of managed care has led to the introduction of many positive elements, including greater emphases on populations, prevention, outcomes, clinical epidemiology, evidenced-based decision-making, quality improvement, team care, and systems thinking. On the practice side, as we’ve witnessed the efforts of managed care organizations to attract larger clienteles through customized appeals, we have recognized the importance of modifying our curricula to emphasize patient- and family-centered care, cultural competency, and communication skills. And, as we’ve witnessed managed care’s crusade to blunt the escalation of health care expenditures, we’ve come to appreciate the importance of preparing our students to be more cost-conscious and to be better managers of scarce clinical resources. I think we also have to credit the practice of managed care, however indirectly, with the welcomed renewal of interest in medical professionalism. In principled reaction — or should I say revulsion — to the commercialization of medicine brought on by managed care, educators are making valiant attempts to reinforce the core values of medicine and to ensure that our students are well grounded in the profession’s ethical principles of beneficence, honesty, and integrity. If those are managed care’s positive contributions to medical education, what are the negatives? First and foremost, of course, is managed care’s role in eroding the clinical revenues so instrumental in establishing America as the world leader in medical education. But a negative financial impact is only part of the downside. Managed care organizations have by and large thwarted medical educators’ attempts to find adequate outpatient venues where students can experience contemporary medical practice. Very few of these organizations see themselves as “academic” and are willing to bear the costs of participating in education. At the same time, independent practitioners appear less willing to volunteer their time for teaching because of the economic constraints placed on them by their managed care contracts. The same holds true within the inner circle of the academy, as full-time faculty express concern that teaching time is being sacrificed to meet the demands of managed care. And this concern contributes mightily to the evident deterioration in faculty morale, which has an adverse effect on virtually everything. One other possible negative effect of managed care deserves mention, and that is the declining applicant pool. Although unquestionably multifactorial in origin, the falloff in medical school applicants is most likely a reflection to some extent of the gloomy picture of medicine’s “managed care” future portrayed in the media and expressed by many disillusioned practitioners. Given this mix of positives and negatives, the question remains: can medical education flourish in the era of managed care? The answer can certainly be yes, but only if we enthusiastically embrace the positive lessons that managed care has to offer and stiffen our resolve to overcome the negatives by rededicating ourselves to our core educational mission. Jordan J. Cohen, M.D. |
|
||
|
Contact Us © 1995-2008 AAMC Terms and Conditions Privacy Statement |
“Managed
care,” the darling of health policy wonks a decade ago, has
become the villain that everyone loves to hate. Politicians, patients,
and health care professionals alike now decry managed care organizations
as heartless bureaucracies that bury providers in red tape, place
draconian limits on access to care, and generally endanger health
care by putting profits ahead of patients. Leaders of academic medicine,
likewise, are fond of blaming managed care for many of our current
troubles. In the interest of fairness, however, I think we have
to look beyond these platitudinous views and consider seriously
managed care’s positive as well as negative impacts on medicine.