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Health Care Reform:

Health Insurance & Affordable Care Act

Consumers Give Open Model of Managed Care Five Star Rating


On the other hand, Carter agrees that the "Mother may I?" model of health care -- in which every decision, every expenditure is tightly controlled by the managed care company -- isn't necessarily the answer, either, which is why it's going out of style. "Physicians and consumers alike don't like to be told that this surgery is unnecessary or it's not necessary for that extra battery of tests. ... All that stuff makes people cranky."

In fact, Carter says most of his association's members would likely agree that having physician groups in charge of making health care decisions is probably the best way to go -- but says that type of system can potentially get out of hand. "Some degree of choice and open access makes sense," he says. "The danger is ... we'll wind up with overtreatment."

Not everyone agrees: "You're medically-legally liable," says W.C. Williams, MD, senior vice-president of the National Association of Managed Care Physicians. "So most of my colleagues do what's medically appropriate anyway. That's what we've been taught and that's how we treat patients."

Vital Information:

  • An open system of managed care, in which a private physician's office works under contract with a managed care provider, works better than a closed system, or managed care facility, according to a new study.
  • Consumers rated the open model better in access to care, continuity with the doctor, and quality of interpersonal relationship with the doctor.
  • Researchers say the primary explanation is that doctors in the open model provide better customer service because they are solely responsible for the doctor-patient relationship.

Latest Health Reform News

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