Aubrey O. Hampton Lecture. Can radiology save managed care? Preserving quality in the face of managed competition.

Abstract

T he 1990s have been a roller-coaster ride for those of us practicing medicine in America, especially in those states where managed care has made its most aggressive inroads. The changes in health care have altered the relationship between doctors and patients and among members of the health care team. But we have to be careful to distinguish between traditional managed care and managed competition. Managed care in the form of nonprofit staff model health maintenance organizations (HMOs) has been with us for decades. It began in the l930s and 40s, providing relatively low-cost, prepaid health benefits for a segment of the workforce that could not afford indemnity insurance. As late as 1981, 82% of HMOs were nonprofit but, by 1995, the number had fallen to 29% [1]. With the emergence of for-profit HMOs and managed competition, the way providers and payers relate to each other has changed drastically. So far, we in Massachusetts have been spared the excesses of managed competition because our environment is dominated by nonprofit HMOs. But the for-profits are coming, and the not-for-profits are changing to compete. I would like to raise two questions: Can quality be preserved in the current health care system? What is our responsibility as radiologists to preserve that quality? To answer these questions, I will explore three issues: What got us to managed competilion? What went wrong? And how do we fix it?