Today's for-profit HMOs (*although very few of these programs are actually pure HMOs, but rather managed care organizations, for the sake of simplicity, we shall use the term HMO generically) are structured so that almost every activity is focused on the bottom line. Their chief selling point is that they can provide a complete collection of health care services for a predetermined, pre-paid, low price. The key to an HMO's profitability is to ensure that as little money as possible is spent in the care of patients. That means that the number of services provided must be minimized, that the price per service must be kept as cheap as possible, and that the use of cutting-edge (usually quite expensive) medical technologies, medications and even hospitals must be carefully controlled. In order to accomplish this, HMOs rely primarily on the following tools. Reduced FeesThe primary method of managed care cost control is to reduce doctors' and hospitals' charges. In fact, in many cases HMOs have used their market power to cut their doctors' fees by as much as 50-75%. While this may seem like a good idea because you believe that doctors either charge too much or make too much money (and perhaps they do), it is important to recognize that a doctor (or anyone else, for that matter) who is suddenly being paid half or a quarter as much for the same service is most likely going to try to make up at least some of the difference by spending less time providing that service and increasing the volume of his or her business. And, indeed, HMOs were specific and up front with the doctors (although not with the patients) about this, promising them that, although they would treat each patient for less, they could make up the difference by vastly increasing the number of patients they took care of. Of course, few, if any, of the doctors expected to have to see twice or three times as many patients per day as before just to cover expenses (which themselves were increased because of the additional paperwork required by the HMOs), but that is exactly what has happened in many cases. And, that is why it is the rule rather than the exception that doctors who work for managed care companies need to hire "physician extenders" (nurses, physicians' assistants, technicians) to do much of the work they used to do themselves.
In some cases, this may, in fact, be more efficient. However, it can just as easily result in less qualified people performing tasks better done by a doctor. And, it always results in patients spending less time with their doctors, which most likely affects the quality of the relationship you form with your doctor and the overall quality of the care you receive,
