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Thursday, September 08, 2005

If Doctor Doesn’t Know Best, Who Does?

An article in the September 6 issue of the Boston Globe reports that Massachusetts Blue Cross will soon begin to require preapproval for certain expensive imaging procedures, such as MRIs and PET scans.

According to the article, Harvard Pilgrim Health Care has had such a program since last year and Tufts Health Plan will initiate one on October 1. These are the other two major health insurers in Massachusetts.

The real significance of these initiatives seems no more to be recognized now than was the case during the managed care era of the 90’s when they were commonplace.

What these insurance companies are saying is that doctors are ordering expensive tests that are not needed. Or, to put it more bluntly, that doctors are making bad decisions that waste money.

Our entire system of health care is based on the principle that doctor knows best. Patients present themselves to doctors, doctors decide what should be done, and the rest of the system is responsible for doing it and paying for it.

Now it seems that insurance companies no longer accept this basic principle. Instead, they are inserting themselves into the medical decision-making process and refusing to honor decisions that they consider to be wrong.

Which leaves us with a big question: If doctor doesn’t know best, who does?

The answer to that question will go far to determine the design of the health care system of the future.

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