On the consumer side, the National Committee on Quality Assurance found that 26.5 percent of patients reported having trouble getting needed care and nearly half said they experienced problems with paperwork and customer service lines. This should come as no surprise, says TIME science and health contributor Fred Golden. "This is what managed care is all about: parceling less care to more people." In such a system doctors will not be able to do all that they want and patients will not be able to obtain all that they seek. "When doctors were in control," says TIME medical columnist Christine Gorman, "costs escalated. To control costs, some care has to be denied." Which is why the ongoing debates on Capitol Hill about managed care are currently stalemated: Neither party is able to come up with a for-profit system that will consistently cut costs and consistently enlarge care.
It all comes down to whether consumers are willing to pay for increasingly costly health care or subject themselves to a form of medical rationing. That's the core issue to emerge from two surveys, released Wednesday, centered on patient and doctor experiences with HMOs. The doctor data, compiled by the Kaiser Family Foundation together with the Harvard School of Public Health, found a high degree of physician dissatisfaction with a system that continually questions their professional judgment. Among the results: 79 percent of doctors reported trouble getting approval for a drug they wanted to prescribe; 69 percent had difficulty getting approval for a diagnostic test; 60 percent noted problems for a hospital stay; 52 percent for referral to a specialist and 38 percent for mental health or substance abuse referrals.