The Changing Business of Medicine (1981-2002, Section 8)
African-American physicians, like all doctors, faced the challenges associated with profound changes in the medical profession at the close of the twentieth century.
Hear Dr. Eula Perry talk about the changes managed care has made to services doctors can provide.
Perhaps the most significant change has been the rise of “managed care,” a term used describe a variety of techniques intended to reduce the unnecessary costs of providing health benefits while supposedly improving the quality of care, the organizations that use those techniques or provide them as services to other organization, and the systems of financing and delivering health care to enrollees in particular programs. The programs are provided in a number of settings, including Health Maintenance Organizations and Preferred Provider Organizations. The growth of managed care was spurred by the passage of the federal Health Maintenance Organization Act of 1973 which required employers with 25 or more employees to offer federally certified HMO options. Today,most people with HMO coverage obtain it through their employment.
While many observers acknowledge that these managed care programs helped to reduce or eliminate some unnecessary medical costs in the 1980s and 1990s, public perceptions of the programs have become increasingly negative. Many disgruntled patients believe that for-profit companies have controlled costs by denying medical treatment or providing low-quality care. Physicians often feel handicapped by programs that restrict the type of services they can provide in any given situation by refusing to reimburse certain procedures. Despite managed care, spending on health care has risen faster than the gross domestic product since 1971.
By the twenty-first century, managed care was ubiquitous in the United States, with some 90 percent of insured Americans participating in some form. However, large portions of the nation remain uninsured and unable to pay for much of their medical care.
The federal government has attempted to address this problem since the early 1950s. President Harry Truman worked unsuccessfully to persuade Congress to legislation providing universal health insurance. In the absence of such coverage, private insurance companies came to dominate the field of health insurance. By 1979, for example, Blue Cross insurance companies covered more than 79 million Americans. Today, they cover almost 100 million people.
Under President Lyndon Johnson’s Great Society agenda in 1965, the federal government launched Medicare, a health insurance program for aged and disabled people, and Medicaid, a health insurance program for individuals and families with low incomes or few resources. Mimicking managed care programs in many ways, these programs have become more restrictive since their inception in terms of covered medical treatment.
Physicians have increasingly chafed at what they perceive to be intrusions into their authority, autonomy, and expertise. Moreover, the complicated procedures and detailed regulations surrounding reimbursements under private or government managed care programs have forced physicians to expand their office staffs to handle insurance claims.