|
|
|
|
|
|
|
|
|
|
WASHINGTON, Mar 07 (Reuters Health) - After years of financial setbacks forced by insurance plans, doctors and hospitals are regaining the upper hand, according to a study released Wednesday. But the study by the Center for Studying Health System Change warns that the power shift, combined with other trends in the health care system, could be bad news in the long run for consumers.
Largely thanks to mergers by hospitals and creation of physician specialty groups, "providers have gained clout," said Cara Lesser, co-author of the study, "Back to the Future? New Cost and Access Challenges Emerge."
The study summarizes four of the 12 site visits the center makes every two years. It includes snapshots of the health care delivery systems in Cleveland, Seattle, Phoenix, and Indianapolis.
The increased reimbursements won by providers are not the only cost pressures facing health plans, according to the study. Increased prescription drug spending and the ongoing managed care "backlash" forcing plans to curb their cost-control techniques are also boosting premiums.
So far, said Center President Paul Ginsburg, PhD, consumers have not felt much of an impact, because employers have been shielding them from increased costs. "The consumer is king for the moment in this era of kinder, gentler managed care," he said at a briefing to release the report.
But Ginsburg said that is already changing for small employers, who are beginning to cut back on dependent coverage and increase employee cost-sharing. And as the economy softens, he says, larger employers, too, may well begin to try to pass some of those increases to workers.
"Over the past few years, most of the horror stories have been about people not getting care because some HMO bureaucrat said no," he said. "In the next couple of years the horror stories may well be people who don't get needed care because they can't pay the cost-sharing."
Other trends are also threatening the health delivery system's very stability, according to the study.
The increase in doctor-owned centers or specialty hospitals specializing in lucrative services such as cardiology, orthopedic, and cancer care, said Lesser, is threatening hospitals by "robbing them of profit centers that cross-subsidize less lucrative, but important departments, like emergency room care."
At the same time, she said, the game of "what could be called 'health care chicken'" being played by hospitals and doctors willing to walk away from health plans rather than accept low payments "is creating network instability" and leaving patients to either change doctors or pay more out of pocket to see a practitioner no longer in their health plan.
The trends have left employers who provide health insurance in a particularly difficult position, said Larry Atkins of Health Policy Analysts, Inc. "Right now there is no clear vision," he said. "Employers are casting around for answers" now that the managed care experiment appears to have failed to control costs once and for all.
Atkins says he sees little evidence of employers dropping coverage entirely or moving to "defined contribution" mechanisms that provide a lump sum in lieu of actual insurance. But he said he does expect to see employee cost-sharing begin to increase.
| Health Topics | Drug Information | Dictionaries | Directories | Other Resources |
|
U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894
Copyright and Privacy Policy, We welcome your comments. Last updated: 08 March 2001 |