Charting the Mainstream

Townsend Letter for Doctors and Patients,  Oct, 2001  by John Weeks

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Consumer Views of Healthcare Decline, Healthcare Premiums Increase, Physician Dissatisfaction, Staffing Issues, Reporting Medical Errors and a Blue Shield Guided Imagery Program

Consumer Views of Healthcare: Getting Worse

The Harris Poll, a national survey company, annually measures whether people, believe various healthcare organizations are doing a good or bad job of serving their customers. From 1997-2001, views fell continuously, although less in the 2001 study. Declines in positive perceptions over the four-year period were as follows: hospitals down from 77% to 67%, pharmaceutical or drug companies from 79% to 59%, health insurance companies from 55% to 39%, and managed care companies from 51% to 29%. In the 2001 poll, the only significant year-to-year drop was hospitals, from 71% to 67%. Humphrey Taylor, chairman of the survey firm, believes that things are likely to get worse before they get better. The reasons: "The forces that have damaged public perception of health insurers, managed care and the pharmaceutical companies are still in place and are, we believe, likely to inflict more damage over the next few years." For instance: physicians will continue to "badmouth" managed care to the media and to their patients; media will feature more stories about how health insurers prevented patients from getting care; spending on drugs will continue to rise; drug price disparities in the US and abroad will continue to be publicized; and an economic downturn "will place an even greater burden on consumers than they are currently experiencing."

COMMENT: To the extent that "alternative medicine" continues to be viewed as a counter to the composite experience, these views suggest an opposite future for CAM. From a strategic perspective, the suggestion is that CAM's place in the consumer's belief system may gain additional value regardless of whether or not scientific support for CAM expands significantly.

Source: "Consumer Backlash Against Managed Care and Pharmaceutical Industries: Bottomed Out or in Remission?" from Harris Interactive, May 30, 2001. http://www.harrisinteractive.com/about/vert_healthcare.asp.

Employers Views: Getting Worse - Health Care Costs to Soar in 2002

Double digit increases in HMO premiums this past year may themselves be nearly doubled in 2002 to 18.5% according to early evidence from employer benefits consultant firm William Mercer and Company. The top reason is that health care providers - hospitals, physicians, etc. - are demanding payment increases following the 1990s years of "managed costs." A related factor,, according to one observer, is that many plans have backed off from the "hard-core, heavy-handed management tools" which came into use during the mid-1990s. Some observers expect 2002 increases to settle out at 14-15% growth over 2001 prices.

COMMENT: The insurance industry is known to go through pricing cycles, with a series of significant increases followed by years in which premiums are closer to flat. Yet a nervousness surrounds these new reports of increases, suggesting that we are witnessing not a natural cycle of give-and-take but a spiral in which the end of the tunnel is represented by the soaring demands on the system by aging baby-boomers. It remains interesting that the "alternative medicine" field, despite growing visibility and internal claims of cost-effectiveness, has yet to be felt as a significant part of any solution.

Source: "Higher HMO Premiums in Store for Employers" by Karen Pallarito. Reuters Health, July 27, 2001

Physician Views: Dissatisfaction Got Worse between 1986 and 1997

Two studies, roughly a decade apart, looked at the views of medical practice among primary care providers in Massachusetts. A major change: those satisfied with total earning dropped from 75% in 1986 to 55% in 1997. Other dissatisfaction was noted in areas of professional autonomy and amount of leisure time. Less than half were satisfied with the amount of time spent with individual patients. Less than two-thirds were satisfied on all major indices. Ironically, given the negative impact managed care is typically viewed as having on physician satisfaction, sharp differences were found among those in "closed model practices" - such as staff model HMOs - versus physicians who take insurance from many different companies. Of the former, 75% would recommend their HMO as a carrier, while only 40% of physicians would recommend a plan for which they provide services. The lead researcher opined that "physicians who have trained more recently are less surprised by what medicine looks like today, whereas physicians who have been in practice longer find the pressures of productivity and competitiveness an unwelcome surprise, which they regard as questioning their professional judgment and their technical expertness."

COMMENT: The story beneath this story is indicated in the last comment. A new generation of physicians is being trained who will not have known the patriarchal "freedom" of the 1965-1985 era when MDs called all the shots, billed for whatever they wanted, whenever they wanted it, profited from referring patients to their own labs, had little accountability, and never had to question whether their care was sufficiently "patient-centered." The dissatisfaction of the old is not all a bad thing. Then again, medicine will continue to draw, considering that entry-level family medicine is running $130,000 and up. People put up with a lot of grief and dissatisfaction in other businesses for that kind of money.