Word: payes
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Dates: during 1980-1989
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Those who, like Ponce, lament the anonymous quality of their treatment reflect a second revolution in patient care: the rise of the medical- industrial complex. Every bit as important as the advances in technology are the means of delivering them and deciding who should pay. Instead of an individual doctor seeing his regular patients in the privacy of his office, the typical encounter now occurs in the thick of a vast corporate hierarchy that monitors every decision and may weigh in against it. Marketing medicine has become very big business...
...costs have risen, the past decade has seen an explosion in prepaid, "managed" care. More than half of all physicians work in some kind of group practice, most commonly a health-maintenance organization. Patients pay a flat annual fee in exchange for care that is provided by HMO member doctors. As private corporations, many HMOs can be quite profitable -- so long as their patients do not get too sick. The number of patients enrolled in HMOs has doubled in the past five years, to 32 million, often at the urging of cost- conscious employers. The goals: efficiency through greater competition...
...choose who will treat them, and can be lost in a shuffle between rotating doctors. The physicians, meanwhile, are transformed from professionals into employees, with a duty to serve not only the interests of their patients but the demands of the corporation as well. "They're asking physicians to pay for their decisions," says internist Madeleine Neems in Lake Bluff, Ill. "That's a terrible concept. When you analyze whether or not a patient needs an expensive test, a lot of times it's not a clear-cut yes or no. I don't want my finances tied into those...
...ultimate price of inflated expectations and consumerist attitudes is the treacherous legal reality that confronts doctors today. Anything short of perfection becomes grounds for penalty. And once again, while it is the doctor who must pay the high insurance premiums and fend off the suits in court, the patient eventually pays a price. The annual number of malpractice suits filed has doubled in the past decade and ushered in the era of defensive medicine and risk managers. No single factor has done more to distance physicians from | patients than the possibility that a patient may one day put a doctor...
Whether those assets are immediately found is not imperative. Houghteling said that once the state levies its tax bill, it will have six years to collect. "So if three years from now [a dealer] buys a house on the Cape, that could be held to pay off his tax tab," she said...