Average expectations - basing managed-care on averages gives a wrong message of sheer commercialism to consumers since there is no 'average' employee - Editorial

Business & Health, Dec, 1996 by Richard Service

There's a paradox in the results of Business & Health's Executive Opinion Poll. On the one hand, employers told us that they expect nine out of 10 workers with health benefits will soon be covered by some form of managed care rather than traditional indemnity insurance. On the other, they've barely begun to use the tools for managing care--including screening and wellness programs that target cancer, high blood pressure, obesity, smoking and a host of other conditions and risks.

Assorted items in News & Trends reveal the consequences. The majority of respondents to a national poll, for instance, either hadn't heard the term managed care or didn't know what it meant--and half of those who professed to know what an HMO was didn't make any connection to preventive care. Other research concluded that most people don't trust their employers to provide reliable information on the quality of health plans and that they are most likely to turn to family and friends for recommendations about doctors or hospitals.

Could we ask for stronger evidence that the public has thus far received a message of managed cash rather than managed care? They detect and dislike the mind set that is quick to assume lower profit margins must be offset by higher prices, rather than ask whether a maturing industry should adjust its profit expectations. Their impression of single-minded focus on finances is strengthened by the tendency to manage by averages. Thus, health plans can make the quantum leap from a guideline that suggests the possibility of same-day discharge after mastectomy if clinical and psychological supports are in place at home into a requirement for immediate discharge.

People are not convinced by arguments based on averages, for none of them is the mythical "average person." Their individuality is at the core of a truth known to many and forgotten by some: Medicine is not an exact science.

As such, it is not something to be practiced by committee or by legislation. Thus, mandating lengths of stay after childbirth had enormous popular appeal, but was a very bad precedent--one that may now be extended by the equally wrongheaded notion of required lengths of stay after mastectomy. Bravo to the American Association of Health Plans for heeding the voice of the consumer and arguing that such decisions should be left to physician and patient.

AAHP's stance acknowledges the role of market forces. Such consumerism is enlightened self-interest. Providers must understand and accept it if they wish to shape 21st century vehicles to deliver health care and merit a return on investment.