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Despite the controversy over whether Medicare HMO patients receive adequate end-of-life care, 69% of Medical Ethics Advisor readers say patient care is somewhat or seriously diminished as a result of managed care. The 1997 reader survey conducted by the newsletter asked readers for their perspectives on how managed care affected patient care. The results may either confirm or dispel your own beliefs, depending on how you look at them.
By far, readers’ biggest concern about managed care’s impact is on the physician/patient relationship. Most readers who explained their answers stated that the physician/patient relationship was undermined by the constraints of managed care. The reader survey question read: From your perspective, how has managed care affected patient care?
Here’s the breakdown:
• greatly improved patient care, 0%;
• somewhat improved patient care, 15%;
• no effect on patient care, 11%;
• somewhat diminished patient care, 54%;
• seriously impaired patient care, 15%.
Readers who chose the last option explained how they perceived managed care to impair patient care. Responses included:
• Managed care disrupts physician/patient relationships, which then impairs trust and communication. It breeds disloyalty in both directions.
• Physicians tend to spend less time with patients as do RNs, again leading to poor communication.
• Managed care organizations are too restrictive without knowledge of situations.
• Money is a poor reason to discharge a patient.
• Health has become a commodity, and access to certain care has been cut by cost.
• There’s a loss of control.
• There’s a conflict of interest because the physician/patient relationship is put in jeopardy.
• Managed care impedes referrals to specialists.
• Patients have become consumers.
• Managed care undermines patient/physician relationship and the public’s trust in the medical profession. Medicine is not a business, and medical care is not a commodity.
• Insurance companies dictate medical care with no liability.
• Physicians have time constraints on treatments, and patients are left feeling as if they haven’t received the best care possible.