Wednesday, July 30, 2014
Doctors and Insurance Companies
Should insurance companies have the right to overrule
doctors?
That question is currently being debated indirectly in the
Massachusetts legislature.
Massachusetts has recently experienced a spate of deaths
related to recreational drugs and the families of addicts are pressing the
legislature to require health insurance companies to cover inpatient
treatment. The insurance companies, with
the support of a number of organizations and individuals in the treatment field, claim
that inpatient treatment of drug addicts has been demonstrated to be outmoded and
usually unnecessary.
The issue was the subject of a lengthy article in the July
29 issue of The Boston Globe discussing two bills dealing with it, one in each
house of the legislature. Reading
through it, I was struck by the following sentence appearing in all innocence about
a third of the way through:
“Especially worrisome to insurers, both bills limit
insurers’ ability to override treating physicians’ decisions.”
In my day, the very idea of insurers overriding medical
decisions would have been rank heresy, but apparently no more. Now it seems as though it is well enough
accepted that insurers can openly claim the right to do it.
I think it is something to worry about. But the medical profession has brought it on
itself. By failing to require its
members to adhere to best practices, it has created the need to which insurers
are responding.
I hope the day is not too far off when capitation will be
the dominant form of payment and decisions about effective treatments are made
by providers. I would much rather those
decisions be in the hands of my local hospital and its medical staff than in the
hands of insurance companies trying to maximize value for investors.
