Health Benefits 21st Century Style. Ooops, some things never change

A read an article recently that began, “as the effectiveness of HMOs began to wane in the late 1990s…” I heard a speech by a noted physician who stated that 25% of patients with diabetes or hypertension are not properly treated and that differences in treatment methods across the country vary by 300% to 500%. All the while, a couple of hundred thousand people die each year from medical mistakes. That makes the goof factor one of the leading causes of death in this country. On top of that, the average consumer is largely unconcerned about costs, and wants only the flexibility to go to any doctor she likes. No matter that a $20.00 co-payment is not reflective of true health care costs. No matter medical schools continue to teach physicians to be independent, individual practitioners despite the need for coordinated group practices where information and treatment methodology is shared. We killed managed care to keep people happy. What will we do to keep them healthy?

Employers are facing a dilemma. Costs are rising rapidly while employees enroll in unmanaged care plans where out-of-pocket expenses are minimal. The only ways to hold the line on health care costs are to increase the portion paid by the patient or employee or to lower the payment to health care providers. We are not going to squeeze more from providers; in fact, the opposite is happening. Providers are pushing back. Employers are reluctant to shift more costs to employees, at least directly.

Enter the new strategy of the 21st century, consumer driven health care. Whether you agree with it or not, you cannot ignore it. Your CEO and CFO will read about it and the press will tout its value. The logic seems simple, too simple. All we have to do is to educate consumers to take a more active role in obtaining health care. Some employers are attempting this with education, others with multiple-choice medical plans and still others with strong financial incentives within a new plan design. Regardless of the method, employers are betting they can get employees to buy health care as they do a new car or TV. In essence, we expect individuals to buy health care without emotion, with a good assessment of value and quality and to be unaffected by the mystique of the medical profession. Is this a transition from managed care to manage thyself?

Employers, the federal government and large insurers failed to change the way health care is delivered, largely because employee/patients rebelled against even the mildest controls intended to improve care. Now we will give each individual a crack at the task. Good luck to us. If we fail again, the financial crisis will mean the end of health benefits in some companies. 

 

 

Recall the rhetoric of the health care debate. “No one should come between you and your doctor.”  “If you like the plan you have you can keep it.”  And also consider the direction we are headed with less and less in out-of-pocket costs and more and more services covered in full.

 

 

Related Articles

• The Myth of Consumer-Directed Health Care (thehealthcareblog.com)

 

 

 

 

Oh, I wrote the above article nine years ago in 2002  (a version appeared in Employee Benefit News)