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Making Provider Choices in Managed Care

How to make the wise choice in a primary care physician.
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The Government's Role continued...

"Normally people don't want the government to be involved unless they don't trust the health care system," says Les Zendle, MD, associate medical director of Kaiser-Permanente in Southern California. "This is most often the case for patients who have chronic diseases or special medical needs."

The public's mistrust has lead to legislation in several states that allows a consumer to select a medical specialist to serve as a PCP, says Molly Stauffer, senior policy specialist with the National Conference of State Legislatures (NCSL). In a study of medical access released in October of 1999, NCSL reported that 18 states and the District of Columbia now require managed care plans to allow a woman the option of choosing an obstetrician-gynecologist as her PCP. A number of other states also allow a woman direct access to an ob-gyn without first getting approval from her PCP.

Blendon believes the trend of specialized access may expand. For example, laws may be put into place that let parents select a pediatrician PCP for children. "In general, the managed care companies that grow the fastest tend to be the ones that offer the most choice," he says.

Personality Counts

In selecting a PCP, you should consider how well he or she communicates with you. Ray Werntz, president of the Consumer Health Education Council in Washington, thinks openness is the base of a good doctor-patient relationship.

"Consumers can go online when selecting a PCP and find out where that doctor graduated from medical school or how they did academically, but the PCP who listens well may be much better than the one who graduated at the top of the class," he says. "What happens between the doctor and patient isn't always medical. It's also about relationships."

Werntz believes that whenever a patient is denied access to the doctor he or she wants, frustration and mistrust in the entire system is sure to follow. "That's why consumer demand for choice is so huge," he says.

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