The Medical Society of the State of New York
September 2, 2008
The Medical Society of the State of New York just released survey results, which indicate that health insurer rules often force New York State physicians to alter the way they treat patients — and not necessarily for the benefit of patients. Instead, the rules appear to have been developed to increase insurer profits at the expense of the best health practices and patients’ health.
The survey results indicate: Ninety percent (90%) of the physicians surveyed said that they have had to change the way they treat patients based on restrictions from an insurance company, and 92% said that insurance company incentives and disincentives regarding treatment protocols “may not be in the best interest of the patients.”
Physicians’ most common complaint was that health insurers required them to change prescription medications; 93% of the physicians voiced this complaint. Over three-fourths (78%) said that an insurance carrier has restricted their ability to refer patients to the physicians they believed would best treat their patients’ needs.
A majority (87%) of physicians said that they sometimes feel that they are pressured to prescribe a course of treatment based on cost rather than on what may be best for the patient. Over half (62%) of the physicians surveyed, however, are either somewhat concerned or very concerned that they may be cut out of an insurance network if they do not follow the policies requested by insurance companies.
Complete survey results:
By Don McCanne, MD
No person disputes the fact that it is wise to use a less expensive generic medication when a newer product on patent is more expensive, has not been shown to be a better therapeutic agent, and has not been in use long enough to identify potential adverse effects that only post-marketing surveys could demonstrate.
A public insurance program would be designed with incentives to provide the best care possible, with secondary incentives to avoid more expensive options that have no advantage over less expensive options. For example, a $100,000 cancer drug that has not been demonstrated to be any more effective than established agents, and which has a 100 percent incidence of toxic side effects, may not be covered by a public program except perhaps as part of an approved research protocol.
This survey once again confirms that private insurers are intrusive in the patient-physician relationship. We know that their interventions are based on business contracts that they have with pharmacy benefit managers and pharmaceutical manufacturers. Their business interests take precedence over the interests of the patients. In some instances, recommended changes may incidentally benefit patients, but they are made only after the insurers first have made a determination that the change will benefit their bottom line.
Moreover, insurers usually dictate which specialists and which hospitals can be used without the patient incurring significant financial penalties. These authorized referrals are based on provider contracts that accrue to the benefit of the insurer without regard to the wishes of the patient and the advice of the physician. In a well designed public program, patients would have choices within the full range of provider options.
Before we adopt reform based on the private insurance model, we should think about what that means. Amongst the great multitude of problems, we would be adopting a system that allows businessmen to intrude between the patient and the physician and take away with them whatever money they can. That doesn’t seem wise when we could have our own public program that is designed to provide the best care for all of us with the resources that we have.