Inscos want to own your health care provider

| by The Pediatric Insider

The Pediatric Insider

© 2011 Roy Benaroch, MD

 We cut out the middleman to SAVE YOU MONEY!

It works with jewelers, car dealerships, discount chains—cut out that greedy middleman, and the buyer gets the goods, cheap!

Will it work for health care?

Here’s a new trend: insurance companies owning their own retail-based clinics. I’ve raised some red flags about retail clinics in drug stores and big box outlets before. One objection I have is the conflict-of-interest: if the drugstore will also make a profit when it sells you the drug, could it be that their salaried employee will want to prescribe the medicine that makes the most money for the drug store?

Take it one step further—what if the insurance company itself actually employs the health care provider? Every dollar spent on you is one less dollar of profit for the company. Do you think their provider is likely to order the best medicine, or the cheapest medicine? How about those blood tests or x-rays–you’d like to be sure that the person deciding whether to order them cares only for your well-being. What if the person who decides whether to order the test works for the company that has to pay for it?

Drug-store owned clinics are a huge conflict of interest, but at least the impact of their decisions is really limited only to medication choices. With insurance company-owned clinics, decisions aren’t just about who makes profit on the medicines. It’s about everything: how many specialist referrals there are, whether you’re told to go to the ER, whether you get an MRI on a knee or your brain. Every decision to offer anything past rudimentary, inexpensive care is less profit. Who do you want making these decisions?

The way health care is financed, “the middleman” is your doctor. Physicians are not beholden to the insurance company—we can pretty much order what we think is appropriate, without affecting how we’re paid for the encounter. (There are ill-defined “bonuses” to reward what’s considered “good care,” but those payments are minimal and unpredictable. And sometimes we have to jump through hoops to expensive things pre-approved, but whether they’re “approved” or not, we doctors still get paid.) Furthermore, I don’t actually make money on the stuff I order. You go get your MRI somewhere else, you go buy your medicine down the street. I decide what you need based on what I know about you and my best medical judgment. That’s the kind of middleman you need: a person squarely in your corner, looking out for only your interests.

Insurance companies are there to make money for their shareholders. Period. Who do you think will win when they alone decide what services you get?

Filed under: In the news, Pediatric Insider information