.. are should be done away with, and almost everyone would like to see more cost effective care. It is when the argument reaches the categories of “uncertain effectiveness” and “ethically troubling” that things get interesting. Most physicians are likely to resent an intrusion upon their clinical judgement, patients would be unlikely to accept denial of a procedure they think to be beneficial, and the world can never seem to agree on what is morally correct.
“While many physicians will refrain from performing procedures known to be ineffective, most will not be willing to unilaterally cut [sic] other ‘wasteful’ activities” (Marmor 106). HMOs are overly concerned with profit margins. The physicians employed by them work under a system of capitation through which a physician receives a certain amount of money per patient no matter the frequency of office visits. Dr. Ronet Lev, an emergency physician at UC San Francisco Hospital, states: “When I was in medical school, which wasn’t that long ago, you would do the best for the patients. Now, with the capitated system, the pendulum has swung the other way and instead, you do the least” (Uche).
In order to increase profits, the doctors employed by HMOs are continually having to take on cases they are not wholly prepared to deal with. Practices such as psychiatric evaluations and even minor surgery are now found within the realm of the primary care physician. Some HMOs give doctors monetary benefits and financial incentives to reduce the number of patient referrals to specialists and to ensure the care given comes at the least expense. “These financial incentives create what many doctors see as an ethical conflict: the less care they give patients, the more money they make” (Uche). Some HMOs are actually using a new technique called “telemedicine.” In these programs, sick patients are encouraged to call a phone service through which nurse practitioners, rather than doctors, receive the individuals’ complaints and make diagnoses and prescribe treatments without physical examination. The drawbacks of this practice should be obvious — but the bottom line is that it is cheaper to pay a nurse practitioner to prescribe on the telephone, rather than to pay a doctor to examine the patient (“Did You Know”).
With the lure of alleged inexpensive care, many poorer families and individuals are drawn to the HMOs. The elderly are being especially hard hit. The federal government sees the HMOs as a way to cut back on medicare spending. Thus, medicare and medicaid subscribers are forced into substandard care. A study done by a group of individuals and published in the Journal of the American Medical Association concludes that the subgroups of poverty stricken families and the elderly are affected most by the HMO healthcare practices.
One of the results was that for elderly patients (those aged 65 years and older) treated under Medicare, declines in physical health were more common in HMOs than in FFS (fee-for-service) plans (54 percent vs 28 percent; P.