In response to the previous post, I agree that there are good and bad aspects to the increasing prevalence of managed care in our society, the bad ones including the one you mention of restricting access to specific drugs or treatments on the basis of cost. This policy that seems to put cost first and the patient last appears to be the guiding principle in too many cases. It is in my opinion a sad reflection on our society that the patient’s needs become secondary to maintaining the bottom line for the Health Insurance companies. An example quoted by Faloon & Strum (2010) is a drug called Provenge® that has proved to be highly effective in treating prostate cancer. However, due to extensive testing requirements imposed by the FDA, it took eight years to become available and cost $93,000 per patient. Hence it is most unlikely to be available within managed care plans. These battles over access to needed drugs can also – obviously – cost lives. The patient you mention in your post may be past help from the wanted drug if it ever is agreed.
Whilst I take your other point about Managed Care making the best procedures and care available to patients, I don’t accept that is always the case in practice. To make the best diagnosis the doctors may need to recommend certain tests, which may be expensive (such as using the latest scanning technologies). It is likely that the doctors would have to get authorization from the insurers before offering that test to the patient. Conversely, due to fear of malpractice litigation, doctors in the managed care environment are inclined to practice “defensive medicine” which can mean ordering extra (possibly unnecessary) tests to cover themselves, but which increases the costs (Hauser et al., n.d.). Having said that, I do agree that the insurance companies should take heed of what the doctors tell them, but sadly the cost is always likely to be the overriding factor.
References
Faloon, William & Strum, Stephen, B. (Nov 2010). “FDA Delay of One Drug Causes 82,000 Lost Life-Years.” Life Extension Magazine. Retrieved from http://www.lef.org/magazine/mag2010/nov2010_FDA-Delay-of-One-Drug-Causes-Lost-Life-Years_01.htm
Hauser, M.J., Commons, M., L., Bursztajn, H., J. and Gutheil, T, G. (n.d.). “Fear of Malpractice Liability and its Role in Clinical Decision Making.” Retrieved from http://www.pipatl.org/bibliography/hauser/malpractice.html
