Special Session ~ November 10, 1997: Discussion on Managed Care

Managed care, as we know, has not fulfilled its potential for providing health promotion interventions to the American people. What can we do to change this?

Dr. Helen Rodriguez-Trias

Public health is really in a very good position to make the point that in order to make health care in the managed-care modality or any other modality, prevention has to be built in. Moreover, in order to really be effective, there has to be increased coverage of the population and to have population-based outcomes. So my firm belief – and we see some glimmers of it already – is that, if public health presents its position very strongly, it will make the case for the need of incorporating public health principles and practices to guide managed care to make it more effective.

Dr. Victor Sidel

If managed care had as its main purpose the maintenance and improvement of the health of people and communities, managed care might indeed be induced to invest in prevention. But managed care is largely about reducing costs and making profits in medical care, even in the non-profit sector. Therefore, until we change the very nature of what is called “managed care,” prevention will not be able to make any important inroads into this misnamed element of the U.S. medical care system.

Dr. Richard Brown

We can make some very strong inroads into managed care and force it into a mode in which it is active on behalf of population –based health and prevention of disease. Two examples. Minnesota has had the wisdom to pass two laws that are critical to making managed care serve the needs of people much better than managed care does in most of the rest of the country. One law prohibits any for-profit health plan from operating in Minnesota. So all of the plans in Minnesota are non-profit plans and most are based in Minnesota. The second law requires all health plans, including managed care plans, to develop collaborative-action plans with local health departments and community-based agencies to undertake activities that promote the health of the population and target specific health problems and risk factors in the community. Together, these two laws and their effective enforcement have actually brought about some significant changes and some significant prevention activity in Minnesota.

Dr. Myron Wegman

As a victim of the managed care program in Ann Arbor, Michigan, I have strong feeling about the supposed attention to prevention. I regularly receive health promotion pamphlets with lots of general advice. What disturbs me most is that, in my managed care program and in general, none of them have looked at individualizing prevention.

Dr. Eugene Feingold

Managed care is only concerned about managing the care or providing prevention for the “covered lives.” We still have in this country 40 million people who are “uncovered lives.”

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