No More Accountants in the Operating Room?

  • Share
  • Read Later
It appears that the pendulum of managed care may be swinging back toward doctors and their patients. In a move that's being described as "extraordinary," UnitedHealth Group, the country's second largest health insurer, will announce on Tuesday that it plans to place more faith in its member doctors' diagnoses. The health plan, which insures more than 14 million Americans, spent $100 million in the past year scrutinizing doctors' recommended treatments, and, according to plan officials, ended up approving 99 percent of them. To trim these costs, executives have turned to a novel idea: Let the doctors decide what treatments are medically necessary, and let it go at that. "It's just extraordinary," Robert Blendon, a Harvard University professor of health policy, told The Dallas Morning News. "Here they are saying that there are other ways to save money without rationing care. It removes a fundamental tenet of how these plans have been operating in order to be cost-effective."

The decision is oozing with irony: In recent years, the idea of medical "cost-effectiveness" has become synonymous with insurance plan bureaucracy, evoking images of penny-pinching accountants heartlessly rejecting pleas for medical help. Could Tuesday's announcement be the first pebble in an avalanche of new health plan policies? "Sure, it's one company," says TIME Washington correspondent Dick Thompson, "but it's the second largest in the country, and this is a very important move on their part."