Health Care Rationing Through Inconvenience: The Third Party's Secret Weapon
Grumet, Gerald W.
New England Journal of Medicine. 1989 Aug 31; 321(9): 607-611.
In a Sounding Board article, a physician takes third party payers to task for containing medical costs by "slowing and controlling the use of services and payment for services by impeding, inconveniencing, and confusing providers and consumers alike." Managed care systems such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) and governmentally based and publicly funded programs like Medicare and Medicaid, are given as examples of carriers for whom inefficiency is profitable. Grumet identifies and discusses eight bureaucratic mechanisms used by carriers to impede the delivery of and payment for health services. He argues that these mechanisms deter patients from seeking care and physicians from offering it. He calls for methods of medical cost containment that are "rational, explicit, equitable, and free of ambiguity, deception, or harassment." (KIE abstract)
Containment; Carriers; Deception; Economics; Federal Government; Financial Support; Government; Government Regulation; Health; Health Care; Health Care Delivery; Health Insurance; Health Maintenance Organizations; Health Services; Health Care Rationing; Industry; Insurance; Methods; Managed Care; Organizational Policies; Organizations; Patients; Physicians; Public Policy; Preferred Provider Organizations; Records; Regulation; Resource Allocation; Review; Selection for Treatment; State Government;
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