Can HMOs do better?
From the July/August 1995 ACP Observer, copyright 1995 by the American College of Physicians. By Deborah Gesensway From his position as director of ambulatory care at one of the public hospitals where New Yorkers on Medicaid get most of their outpatient and inpatient health care, Robert L. Braham, FACP, can reel off dozens of reasons why he thinks the rush to drive most Medicaid recipients into managed care plans means trouble for patients and for physicians. Access and income top his list. In his next breath, however, Dr. Braham hints at an ambivalence that reveals the complexity of the debate about reforming the nation’s health insurance program for the poor. Despite his reservations, he can see how Medicaid managed care could benefit patients and physicians. “These are people who need health care,” Dr. Braham said. “Poor sick people are the people who benefit from getting good access to preventive health care … and who need to have an ongoing relationship with a competent primary
