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.

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