Whats happened to the doctor-patient relationship?
We’ve always had a set of multi-level relationships in health care between the doctor and the patient, but then once insurance came into the picture there was also this third level. The doctor and the patient made some arrangement about what appropriate treatment was and then the insurance company, they came in from the outside and paid for it. But in the new contracts, in managed care contracts, the insurance company has more of a say in what is covered by that contract and what is not covered. So they can say, “You can’t go to Dr. X. That’s not in your contract.” And the employer has some negotiation with the insurance company to arrive at that. It isn’t entirely clear how that affects the doctor-patient relationship. It need not, but it does affect the payment relationship to the doctor and the patient. And that leaves both of them at a different kind of risk than they used to face. Talk about problems regarding individual versus group insurance. There’s actually no period in Americ
