This was one of many difficult questions explored by four Emory health sciences experts at a panel discussion titled "Do You Want Your Care Managed?" presented Nov. 10 as part of Alumni Assembly XIV.
Panel moderate Rein Saral, noted oncologist and director of the Emory Clinic, said that finding a situation from the history of medicine comparable to the managed care revolution of the past decade is difficult. One must go back to he early 20th century to the Flexner report, which revolutionized medical education, to find a scenario that even comes close, he said.
The managed care revolution Saral cited began in large part as an attempt by large employers to reduce their health care costs. Saral said the jury is still out on whether managed care will ultimately save a significant amount of money in health care costs.
Panelist Randy Martin, an Emory cardiologist, said a guiding principle of managed care has always been focusing on preventive care to reduce the number of costly illnesses such as heart disease and cancer. "Prevention is a tough sell in American medicine," Martin said, "but it is the answer" to reducing the number of costly illnesses. Martin said he is particularly interested in how people learn about what health care providers do and how they learn to keep themselves healthy. "People haven't traditionally learned that from health care workers," Martin said. "They've learned it from the media. We must be more proactive in getting out the right messages" about illness prevention.
Regardless of the cost-saving potential of managed care, Ned Baker, associate professor in the School of Public Health, said that health maintenance organizations (HMOs), the health care networks upon which the managed care concept is built, are here to stay. Baker said that while the number of HMOs in the United States decreased from a high of 703 in 1987 to 540 in 1993, the number of people receiving health insurance through HMOs has nearly doubled in the same period of time, from 25 million to nearly 50 million.
"Half of those enrolled in HMOs are in non-governmental programs," said Baker. "American business really has embraced HMOs. It will be very hard not to have at least some portion of your care managed in the future."
This trend toward managed health care is not an American phenomenon, according to panelist Rick Gilkey, director of the Center for Health Care Leadership in the School of Medicine. "Health care costs as a portion of gross national product are increasing faster in Japan, Germany and France than in the United States," Gilkey said. "The United States is probably in the middle of the pack." Efforts to stem spiraling health care costs in the United States, Gilkey said, have been too narrowly focused on isolated elements of the system. Future cost-containment efforts must be approached more comprehensively, he said.
--Dan Treadaway