Money and Medicine
The Medline database contains many articles of interest related to prosthetic and orthotic practice, although they are generally from the physician's perspective rather than that of the CPO. I prefer to access these journal summaries through Medscape. Interested readers can obtain a free membership at www.medscape.com that will allow searching the massive Medline database, which includes almost every medical article published in the English language.
Medscape also offers the option of subscribing to an electronic newsletter highlighting recent medically-related publications of general interest. One of the recent issues summarized five articles on the business of health care under the heading "Money and Medicine".
The second article reviewed, from the New England Journal of Medicine, noted the remarkable improvement in patient care within the Veteran's Administration since 1994, and attributed much of this accomplishment to relatively straightforward changes in policy, such as the institution of routine quality measurements for high priority conditions such as diabetes and heart disease and the public disclosure of the results. Equally noteworthy, these improvements occurred during years when there was essentially zero increase in the VA's budget while the number of patients increased 40%.
Another summary discussed the possibility that the US will move to a single payer National Health system in the future, noting that public dissatisfaction with Managed Care is rapidly increasing as we enter the third consecutive year of double digit premium increases despite cost containment promises. Private studies and a 1990 Government Accounting Office study have concluded that a single payer system would streamline claims processing and extend coverage to more Americans.
To quote the summary, "The working formula for single-payer models relies on several key factors: Tapping the huge sum of money already spent on healthcare and applying it more equitably; throwing out managed care organizations and their higher administrative costs and profits; and providing basic healthcare for the poor who now receive treatments mainly at expensive emergency departments."
Not everyone is convinced that a single payer system would be a panacea, and one of the critical questions is what treatment and services would be covered. Since more and more Managed Care companies are excluding prosthetic and orthotic care or applying ridiculously low lifetime limits that effectively deny care, our patients might be better served by universal coverage that specifically included appropriate P&O services.
The final article reviewed discusses the impact of a growing trend toward "Consumer Driven Health Care" that replaces the gatekeeper who restricted access in the original Managed Care model with the notion of empowering the insured to make such decisions. Some experts predict that as many as half of all Americans will have the option of choosing such insurance in the future.
Many of these trends will impact P&O practice in the future. Click here to read the summaries and to link to the full text of the articles. [Some publications charge a fee for the full article unless you are a subscriber, but they can usually be obtained without charge from your community medical library.]
