Medicine's role in prepaid medical care plans.

Abstract

I am delighted to have this opportunity to consider the subject of “medicine's role in prepaid medical care plans.” Furthermore, I feel right at home among radiologists because, as a pathologist, I have had to concern myself at times with some of the problems peculiar to our specialties, and we may perhaps have to cope with these issues again before they are resolved satisfactorily. Putting aside what we—radiologists and pathologists—have gone through over the past few years, I would like to review what has been accomplished in the field of medical care, what is now being done, what must be done in the future. Living and practicing in these difficult, changing times, we no longer can confine ourselves to the enormous task of trying to be good doctors and keeping abreast of scientific advances. We also must devote some of our attention to the many social, economic, and political issues which involve medicine. This is imperative because the way in which they are solved will have a vital effect on the practice of medicine, the quality and cost of health care, and the overall socio-economic climate of American life. One of our major problems today is the relationship between medicine and the third parties, of various types, involved in the organization, provision, and financing of medical services. This problem involves our relationship with all kinds of groups which sponsor or operate health insurance and prepayment plans—labor unions, industries, consumer groups, insurance companies, Blue Shield, Blue Cross, and many others. In the past, one of our major difficulties has been the lack of a clear, definitive policy in this area. This has been especially confusing with respect to the principle of freedom of choice of physician, and the question of whether or not physicians should participate in so-called closed panel plans. To help arrive at a sound policy, the Board of Trustees of the American Medical Association, in December 1954, appointed the Commission on Medical Care Plans. After more than three and a half years of exhaustive study, that Commission presented its final report at the A.M.A. Clinical Meeting in Minneapolis last December. Final action was postponed until the Annual Meeting this past June (1959) in Atlantic City, so that the entire profession would have ample time to study the report and formulate opinions. Now, as a result of the A.M.A. House of Delegates' action in June, we do have a policy on the complex subject of third parties. Contrary to some reports and interpretations, the Atlantic City action did not mark a change in A.M.A. policy. Instead, we should view it as the establishment, for the first time, of a broad policy, which naturally will be subject to continual study, clarification, refinement, and revision in the years ahead. Many of you may have read Part I of the Commission report, which contained findings, conclusions, and recommendations. I should emphasize that the A.M.A.