Monday, May 22, 2006

Ritzy Business

Not that many years ago, prior to managed care, almost every woman over the age of 40 had a hysterectomy whether they needed it or not. Or so it seemed . . .

We do know the number of hysterectomy’s dropped dramatically in the few years following the institution of mandated second opinions so you can draw your own conclusions.

But some are now questioning just how well managed care works.

During your next routine medical checkup you have at least a 43 percent chance of undergoing an unnecessary medical test, a new study shows.

It's not like you're getting something for nothing. If you're not having symptoms, and your doctor has no reason to suspect you have a problem, U.S. guidelines advise against giving you a routine urinalysis, electrocardiogram, or X-ray.

Defensive medicine, ordering needless tests as a CYA, is becoming commonplace. All of this is an offshoot of managed care (lower fees) and medical malpractice (frivolous suits for failure to rule out every possible cause of the medical issue).

"This has more harm than benefit," says Dan Merenstein, M.D., director of research in family medicine at Georgetown University. "The problem is, there are so many false-positive results from these tests. They lead to other things, like biopsies."

Another guilty party in this mess is the low copay plan designs that are prevalent, especially in employer provided health insurance. Doctors & patients alike know that the carrier is the one who is paying the freight. Practicing medicine becomes an ala carte process when all that is risk is a copay from the patient and the doc knows the carrier will pay as long as coding justifies the test.

Of course, it really isn’t the carrier’s money . . . the money ultimately comes from those who pay the premium.

And some complain about the high cost of health insurance.
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