Friday, March 17, 2006

Managing Care - the Third Way

In going through the stacks that accumulate around my workplace, I came across a clipping sent to me a couple of months ago by Chuck Kleber, friend. fellow parishioner from Detroit days, and faithful blog reader. It was a column by Paul Krugman titled “Medicine: Who Decides?” as published in the December 26, 2005 issue of the New York Times. Its theme is encapsulated in a sentence found midway through the piece that reads “So if costs are to be controlled, someone has to act as a referee on doctors’ medical decisions.”

The Krugman column, like so many others, entertains only two alternatives. One is government, through publicly operated health insurance. The other is some sort of consumer-driven health care market.

But there is a third way, which might be called Managing Care and which is based on the principle of the HMO. In this alternative, health care institutions that employ doctors and operate their own hospitals – let us call them integrated systems - accept responsibility for managing the care of specific patients within a fixed amount of money set in advance. The Mayo Clinic, Kaiser Permanente, and Henry Ford Health System, are examples of integrated systems. They are properly organized to perform the role I describe. To some extent they already do.

Personally, I would rather have one of these non-profit institutions managing my care than either the government or myself.

It is true that there are at present relatively few integrated systems as I have defined the term. But it is also true that health care providers have been evolving in that direction for some time now and the movement could be encouraged.

Of course, if provider institutions are going to manage care, they also have to manage the clinical practice of their doctors. Getting used to this idea and learning how to do it is the hardest part of health care reform. Nobody can as yet claim to do it well. But it needs to happen and the sooner the better.

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