United Healthcare Dictates Health Care Decisions In Ohio
May 31, 2008
A letter to the editor in the Columbus Dispatch details the problems with big healthcare companies dictating the care that their customers will receive. This is an example of when the market does not work to protect patients rights. Who is looking out for the little guy?
The recent public skirmish over participation contracts between OhioHealth and UnitedHealthcare serves as a stark reminder of how dysfunctional the priorities are within the current health-care environment (Dispatch article, Wednesday). Disagreements and contract disputes between providers and insurance companies are nothing new and have become part of the process — albeit a process that has gotten out of control.
In this instance, a disturbing letter from UnitedHealthcare was sent to all patients of physicians who admit patients to OhioHealth hospitals. This letter informs patients that their doctors “will no longer participate in UnitedHealthcare.” This letter provides no background to the patients about the fact that there is a business dispute between the insurance company and hospitals — which has nothing to do with the patients’ physicians.
The letter merely provides instructions about how to find new physicians. The lack of clarity and context by the insurance company is callous, at best, and has caused needless confusion and turmoil to thousands of patients and hundreds of physicians.
While tensions heat up over costs and reimbursement rates, UnitedHealthcare has completely and repeatedly pushed patients and their physicians to the bottom. This way of operating clearly underscores that in today’s health-care environment, patients are not even close to being considered customers.
Of most serious concern is that the patient-doctor relationship is being threatened by UnitedHealthcare in a cavalier way. Informing thousands of central Ohio patients that their physicians will no longer be in network, without a truthful explanation, is disturbing and threatens good health and good health outcomes. UnitedHealthcare, at a very minimum, should allow for a longer and more efficient transition period as to not cause unneeded stress and anxiety.
The patient-doctor relationship has always been a powerful, personal partnership and is the basis for good medicine. However, over the years, that partnership has become repeatedly strained and is attributable to third-party influences within the health-care system.
Physicians are being viewed by insurers as commodities, cogs in a huge medical machine, instead of as people practicing the art of medicine. The strategies of managed-care organizations such as UnitedHealthcare often place physicians in the middle between patients and insurance companies, by restricting provider networks, limiting what medical conditions and treatments are covered and pressuring physicians to practice in a sort of industrial, assembly-line way, seeing the “right” number of patients every hour, and for lower reimbursement. Physicians and patients who are subjected to such rules and restrictions understandably feel a lot of pressure.
There are real consequences resulting from these bad health-care policies. The communication between physicians and their patients directly affects the diagnoses, treatment plans and adherence to the agreed-upon treatment plans. And, having physicians understand and relate to patients on a deeper level can, in the long run, save time and money.
Years of medical history and a strong relationship between doctors and patients really come into play when treating the individual. It cannot be made up by medical testing and a revolving door of physicians.
The relationship between patients and doctors is good medicine. The blatant disregard of the patient-doctor relationship by UnitedHealthcare should have everyone questioning the current health-care system.
PHILIP H. CASS
Chief executive officer Columbus Medical Association
It is time for someone to look out for all of us. In Columbus, this means that a patient cannot go to major hospitals like Riverside and Grant. Patients all over Central Ohio can no longer see the doctors that they have been using for years. The free market is not working here.
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This is the same United Health Care that gave their recent retiring CEO a 10 Billion dollar retirement?
That is the sum total handed out to Wall Street given to one man.
The health care is managed to get blood out of the rock of the poor.
This is an insult to humanity.
This isn’t a free market - it’s a bizarro world hybrid and it’s no wonder it doesn’t work.
You say the insurance companies are at fault for not treating the patients as customers. That’s because in this system, they aren’t. The company that employs them is the customer - that’s who signs the contract and pays the premium. Insurance companies compete with other insurance carriers to get business from these employers, and will win the business largely on price. Companies are known to switch carriers often to get a better deal. The patients/employees aren’t generally party to the negotiations.
What controls price? Lots of things, but key among them are: a) the claims history of the covered employees; and, b) the rates negotiated with the providers, such as the physicians and the hospitals. In any other industry, the providers would be called suppliers. Isn’t it a good thing when a company negotiates a better deal with its suppliers, especially when that better deal is passed on to the customer in the form of lower prices (practiced to perfection by Wal-Mart)? Doesn’t getting a better deal sometime mean dropping one supplier and chosing another? Maybe OhioHealth is asking for something unreasonable, at least as far as UnitedHealthcare is concerned. Or maybe it’s visa versa. You’ve gotta believe that these guys wouldn’t dig in like this unless there was a lot of money at stake.
OhioHealth is betting that its patients will yell at their employers who will yell at UH and force them to yield. But maybe UH will tell their customers (the employers), fine - go find another insurance carrier. That’s not always easy either. The employer might just tell their employees/patients to go find new providers. That’s exactly what the Hilliard CIty School District did several years running (with the blessing of the union leadership by the way). This is a bunch of big boys slugging it out to get as much money as they can from the others.
The wellbeing of the employees/patients has little to do with it.
The trap we’ve gotten ourselves into is believing that health insurance is the only possible way to pay for health care. That’s not true. I know folks without health insurance who do just fine. They also take very good care of themselves - health wise - because they know being unhealthy is also expensive. By the way, they don’t really do without medical insurance, but they have a very high deductible policy so that if one of them get something like cancer, or need an organ transplant, the insurance will kick in and not completely wipe them out. I wonder what America would look like if everyone did that? Would we all be healthier?
Of course there is the question of what to do for people who cannot afford to pay for their health care out-of-pocket, nor pay for insurance. This is where a true safety net is appropriate. I hope our country is always a place that takes care of those truly in need.
Insurance is all about spreading risk. I buy auto insurance because I believe the risk of getting in an accident is high enough, and the potential loss great enough, that I’ll pay a fraction of the cost of my car so that if it is damaged, the insurance will help out. It’s a fair deal for me because my insurance company knows only a small fraction of its insured will actually make claims. I’ve been buying insurance from the same agent for 30 years, and have never made a claim (okay, once when a deer slammed into me).
In the case of health insurance, EVERYONE makes claims regularly. That’s the reason for co-pays: to try to discourage folks from visiting their doctor frivilously.
And we do need to think more about the sense of the $billions that get spent to fight our final illnesses - 80% of our lifetime healthcare costs. Our family disease is Alzheimers. I’m very concerned that I’ll consume all the family assets as they try to keep me alive for months or years when my brain is irreversibly trashed. That’s exactly what happened with my grandparents - and I’m quite sure they would have said it was a stupid waste of money that they spent a lifetime accumulating.
As I suggested in your other post - we need to either wean ourselves off this hybrid system that isn’t working, or go to a fully nationalized system where the providers are employees of the government.
Can’t have it both ways.
PL
By the way, we’re not the doctors’ customers either. We’re just the ticket they need to bill the insurance carriers - the real customers. After all, we don’t negotiate fees or terms with our doctors - the insurance companies do that.
I wonder how different our healthcare system would be if all you could buy was high-deductible policies and you otherwise had to pay out of pocket for everything?
Or how about we change the tax code so that you have to pay your own medical costs up to x% of your Adjusted Gross Income, but everything after that becomes a tax credit? That essentially makes the government the insurer, but causes us to be more directly exposed to our own healthcare costs. Wouldn’t this give people incentive to live a more healthy lifestyle?
In such a system, the poor would be better protected than now (everyone would be covered), the middle class would be have incentive to live healthier (because the less healthcare you need, the more money you keep), and the wealthy would essentially have a huge deductible before the government kicks in anything.
No way the insurance industry lobbyist would let this happen. When do Americans get to run our country again?
PL
Hi Paul -
You make many good points. I know that our school system likes to shop around for better insurance rates and we have a high deductible plan. Unlike Hilliard though, we pay a lot of the premiums, and I am fine with that.
I think that it does cause people to try to be healthier. The problem is that if your deductible is $2400 for a family and someone needs a surgery, that is a lot of money for some people to come up with out of pocket. I realize that it is better than nothing, but I still think the government needs to get in the ball game.
It has worked with other “first world” countries. (I hate the terms first world or third world)
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[...] United Healthcare Dictates Health Care Decisions In OhioThe recent public skirmish over participation contracts between OhioHealth and UnitedHealthcare serves as a stark reminder of how dysfunctional the priorities are within the current health-care environment (Dispatch article, Wednesday). …Rowsey Blog - http://rowseyblog.com [...]
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[...] United Healthcare Dictates Health Care Decisions In OhioThe recent public skirmish over participation contracts between OhioHealth and UnitedHealthcare serves as a stark reminder of how dysfunctional the priorities are within the current health-care environment (Dispatch article, Wednesday). … [...]
[...] United Healthcare Dictates Health Care Decisions In Ohio31 May 2008 by Jason Rowsey The recent public skirmish over participation contracts between OhioHealth and UnitedHealthcare serves as a stark reminder of how dysfunctional the priorities are within the current health-care environment (Dispatch article, Wednesday). …Rowsey Blog - http://rowseyblog.com [...]