Dr Bob:

While I do agree that the intrusiveness of the "payors" in healthcare is intrusive, I actually think this is on the delcine, rather than increasing.  Patients now have higher co-pays, higher deductables, and more choice than they did 10 years ago (at least in Augusta).  I thier heyday, the HMO's dictated everything about what we did - from top to bottom, we practiced medicine as we did not want to practice it.  Recently there has been a push-back from politicians and consumers, causing there to be more burden on the patient financially.  There used to be just a choice between on-formulary and off-formulary.  Now there are multiple tiers, offering at least the option to pay more and get the medication they want.

This is certainly not all good. Patients are more reluctant to get care when they have a greater burden for the cost of that care.  The days of th $10 copay are long gone - now running in the $30-$50 range. 

What can we do about this?  We can take back the task of doing evindence-based medicine by tracking our own quality.  Insurance companies have always had leverage by knowing the utilization of providers through claims data.  Now, it is possible for us to have better information than the insurers, and hence doing a better job at saving the real payors in medicine the money they spend (that is, the patients and their employers).  If we can do that, we can not only save a lot of money, we can cut the insurers out of the care/cost management came and turn medicine back into a physician managed profession.

Dr. Rob

Augusta, GA

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