The fact that, of all physicians, those in managed care were most likely to fudge speaks volumes about the restrictions they feel at the hands of HMOs. "These doctors are backed into a corner," says TIME reporter Janice Horowitz, who tracks the medical industry. "These practices bespeak not the criminality of the doctor, but a system that is flawed." TIME senior writer Adam Cohen, who covers legal issues, describes such practices as "growing pains of the managed care industry" and thinks that they will correct themselves over time. Cohen reasons that although HMO shareholders demand that the companies streamline costs, doctors, patients and insurance buyers (often employers) will demand adjustments that eventually will lead to looser restrictions and higher premiums. Better get those varicose veins fixed soon.
Lie? The trusty family doctor with the black bag and stethoscope tell untruths? Maybe not the doctor of old, but his successor, the overworked pawn of the bureaucrat-encrusted, coldhearted health maintenance organizations, well, he's likely to tell a few fibs from time to time. Not to you, the patient, but to his employer. A new nationwide study of physicians found that most HMO doctors would lie in order to cut through the red tape and get their patients urgent or even precautionary help. The study, published in this week's Archives of Internal Medicine, found that more than three quarters of managed care physicians believe their primary allegiance is to their patients, not their employers. For example, the majority of doctors said they would claim that a heart condition had worsened after a patient signed up for managed care coverage so the patient could have bypass surgery, if patients with preexisting conditions were excluded from such procedures.