Mismanaged Care

Years ago I belonged to an HMO and had a good experience.  Of course that HMO no longer exists so maybe they were doing such a great job of patient care the company went under. Since then I have had no experience with HMO's but I know someone who has.

Today you must see your primary physician whom you select from  a list without knowing anything about him or her.  Okay, now you've got a doctor but you KNOW you need a referral to two specialists. You are intelligent and knowledgeable about your own health and have seen specialists previously under a different health care plan. So you leave work and trot yourself down to the primary doc.  The primary doctor is very candid and admits she doesn't know anything about your problems and doesn't appear to be concerned about them. But she can't give you a referral until you've tried some over-the-counter remedies. Furthermore her limited advice about your condition is insulting and presumes you are ignorant about basic health care.  So you will have to try the OTC remedy and go back in a couple of weeks to get a referral to the specialist.  Of course you will have to take off work again and see the primary before getting the referral. She has to make sure the OTC medicine didn't work.

To summarize: in order to save money in this system you will have seen the primary doctor twice before getting the referral. You will also be missing hours at work, and that very same company that provided you with such wonderful health care docks you for going to the doctor. If you had just been allowed to make that specialist appointment yourself,  you would have avoided the expense of two useless appointments.

But that would be too rational and keeping costs down is not really what managed care does. At least I can't see how adding two extra doctor visits is efficient. Nor does it protect patient health. While you wait for OTC medicine to work, your condition gets worse and your health declines.  Now you need a specialist in a hurry.  Can you see an HMO physician if you need one right away? I don't know the answer to that and hope I don't have to find out the answer.