Word: himmelstein
(lookup in dictionary)
(lookup stats)
Dates: during 1990-1999
Sort By: most recent first
(reverse)
...just blue-collar employees who are expected to check their freedom of speech at the company door. In mid-December, Boston physician David Himmelstein was fired for going public about the gag clause in his employer's contract with doctors, forbidding them to "make any communication which undermines or could undermine the confidence...of the public in U.S. Healthcare..." or even revealing that this clause is in their contract...
What is it that doctors are contractually bound not to tell people under their care? Most crucially, according to Himmelstein and other critics of for-profit HMOs, the dirty little secret is how their doctors' pay may go up if they limit the treatments they provide or recommend. Himmelstein charges that many HMOs "offer doctors steep financial incentives--what I consider bribes--to minimize care." In his U.S. Healthcare agreement, he says, he was promised bonuses based on a formula for keeping his patients out of hospitals; if the total number of days they spent hospitalized exceeded a fixed number...
HMOs arose and have flourished in the U.S. largely in response to the runaway medical costs engendered under the fee-for-service approach, in which doctors have an interest in doing everything their patients might require, and possibly more than that, provided an insurer is paying the tab. But Himmelstein and other physicians believe the bottom-line philosophy of for-profit HMOs has pushed the pendulum too far in the opposite direction...
...join the type of organization he had previously criticized? "If you want to treat patients these days," says Himmelstein, "you have to become a part of HMOs." Other physicians have felt these pressures and become similarly, if less vocally, disillusioned with HMO practices. One Los Angeles doctor worked dutifully for three years as a neurologist for CIGNA HealthCare, a large HMO. When she advised the mother of a brain-damaged boy that a muscle biopsy might help diagnose the extent of his condition, she was chided by her bosses for suggesting the test. "I was told it was a mistake...
...construed as interfering with the physician-patient relationship. Doctors are encouraged to have open communications with their patients, about treatment, coverage, benefits, even the mechanism by which they are paid. It's just the specific dollar amounts that are to be withheld." But the contract terms cited by Himmelstein seem to prescribe a far greater circumspection from doctors than that...