Healthcare fallacies

By Dr. Philip S. Chua Cebu Daily News First Posted 14:11:00 10/20/2008 Filed Under: Health, Healthcare Providers I just returned from the 94th Annual Clinical Congress of the American College of Surgeons held in San Francisco, California, October 12-16, 2008. Among the hot topics during that convention, besides the various new trends in minimally invasive and robotic surgery, was healthcare delivery system. Thirty-five years ago, the United States enacted the Health Maintenance Organization (HMO) Act of 1973 as a solution to the massive (billion dollars a day) healthcare expenditures. The Americans thought it was the panacea to their healthcare dilemma, and helped pushed for it. But as it turned out, HMO has led to poorer quality of medical care and a lot of bureaucracy and great delays in access to medical care, especially where surgery was concerned. The Americans now realized they made a big mistake and are vehemently complaining to their legislators about it. HMO has now been proven to be “the deadly treatment that is more fatal than the disease.” Today, the US Congress is revisiting the HMO issue. What is HMO? In the traditional patient-doctor arrangement that all of us are familiar with and have been accustomed to, and which is still the predominant existing force in the United States and the Philippine healthcare arena, the patient freely chooses the physician he/she wants to consult. In the HMO system, the patient can only see the physicians who are members of the HMO, even if he/she feels there are other better physicians around, or there is one he/she prefers to see. In some HMOs, the patient cannot even see a specialist directly. He/she has to be referred by the HMO (“Gatekeeper”) doctor to a specialist who also belongs to the same HMO. The patient's freedom of choice is sacrificed. In many cases, even the quality of healthcare, besides the good doctor-patient relationship, suffers. The insurance premium may be cheaper, but it is now apparent to the Americans after that bad experience that indeed, “you get what you pay for.” How was HMO supposed to work? The idea was to cut cost by various methods: requiring pre-certification before a patient is admitted to the hospital, using strict admission criteria; discouraging patients from going to emergency rooms or seeing specialists; mandating physicians to prescribe and use the cheaper generic medications; forcing physicians to use less expensive, and less, diagnostic tests; requiring physicians to discharge their hospital patients sooner, sometimes too soon; decreasing reimbursement to hospitals and physicians by 30 to 50%; refusing to cover and pay physicians and hospitals for certain medical care, illnesses or hospitalization that the company deems “not covered,” etc. It also instituted dozens of “strict and somewhat punitive” rules, criteria, and policies for physicians and hospitals to follow in providing healthcare to patients “if they want to participate in the HMO and be paid at all.”

Did HMO help the people? No. Filipinos. our political leaders. our businesses. to adopt it for our country. HMO. yes. will clearly be hazardous to the health and well-being of our country and its people. The traditional healthcare delivery system is still the major force in the country. if allowed to take root and flourish in the Philippines. Since the United States experience with HMO is a catastrophe as the Americans have found out. Reference: http://globalnation. As a matter of fact. Heart Angiogram. as in the case of this American experiment with HMO.” handicapping the physician in his service to his patients. and another 2 decades or so to have the mistake corrected thru legislature. is more of a health menace organization and. the incentive to do their best is not the greatest.inquirer. Since they get paid the same whether they see 20 or 40 patients anyway. Unfortunately.) are considered “too expensive” by HMOs. The US Congress is now re-discussing the HMO issues and exposing the adverse effects of HMO and the resulting deterioration of the healthcare delivery in the country. Let that painful and inhumane national “experiment” in America be a warning for us Filipinos to be vigilant to protect and preserve our most fundamental privileges: quality medical care. it takes years before people find out the painful truth and complain about it. and the freedom of choice. at a most affordable cost. MRI. and the people and our medical care are the better for it. but fortunately HMO in the Philippines is still in its budding stage. whose main concern appears to be their financial bottom line and not the quality of medical care. More sophisticated tests (CT Scan. HMO has adversely affected medical care and healthcare delivery in the United States. In subtle ways. etc. easy access. Hopefully. and the care much less personalized. since HMO doctors are salaried and are assigned too many patients. Patients feel they have lost their freedom of choice of family physicians and specialists. and most eager to throw it out. the Filipinos. Has HMO invaded the Philippines? Unfortunately. as it stands today.net/cebudailynews/opinion/view/20081020167431/Healthcare_fallacies . they discourage the use of what they consider “too costly tests or medications. the quality of healthcare has suffered and access to care more difficult. wouldn't it be stupid for us. hospitals and physicians can unite and prevent the growth and catastrophic onslaught of US-style HMOs on the healthcare system in the Philippines. The wait in the doctor's office is much longer.

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