Managed Health Care

Throughout the United States there has been an overwhelming
concern as to the status of the present health care system.
Approximately 100,000 people lose their health insurance
each month. Unfortunately the present system does little to
aid these people. It is for this reason that various
managed health care plans have come into existence. Managed
health care is a system by which an outside body, such as a
state or federal government places regulations on the
health care process.
 
St. Luke/ Roosevelt Hospital in Manhattan is currently
operating under a managed health care plan. Vickie Powell,
In-patient Pharmacy Supervisor at St. Luke/ Roosevelt
states that the approach to managed care in the hospital
involves a "Gatekeeper" mechanism. According to Powell,
each patient is assigned a gatekeeper, a general
practitioner who will decide if the patient is in need of a
specialist. If so the gatekeeper will make a referral to a
specialist. Providing the patient chooses to follow the
gatekeeper's referral he/she will be granted the health
care benefits covered under the managed health care plan.
If they are to go against the referral and see a doctor not
recommended, they do not receive the coverage that they
would under the plan.
 
When asked how this would affect the pharmacy aspect of the
hospital, she said "Pharmacy must become involved in the
schooling of the patient about the medicine, where this was
previously the job of the nurse." Besides this, she says,
it would not have a great effect on her department as
opposed to the hospital as a whole.
 
The Managed Health Care Plan has received the most
publicity from President Bill Clinton. His plan calls for
universal health insurance, meaning that no one could be
denied coverage. When faced with the question of what
happens to someone coming into the hospital without any
health insurance, Powell said, "A person can't be turned
away from the emergency room with or without insurance.
This causes a large deficit for the hospital."
 
One of the major problems that most critics see with
Clinton's plan is that it attempts to provide universal
insurance without placing limitations on who can receive
certain types of care. These limitations are present in the
European, and Canadian plans that Clinton's emulates. An
example of such a limitation is dialysis treatment. In the
other countries only people under the age of fifty are
eligible for coverage on this expensive treatment.
 
Ms. Powell does not see any way that the Clinton plan could
go into effect without implementing such limitations.
 
A vast majority of Americans see a need for reform in the
health care system especially on the hospital level.