by Davy James, Staff Writer
With health-care reform one of the major issues discussed throughout the presidential campaign, the shortcomings of the current system are being more closely examined.
Local doctors said the current managed-care system has had a negative impact on the quality of health care and has reduced the time they’re able to spend with their patients.
A recent survey conducted by Monmouth University and New Jersey Monthly found that 78 percent of 2,624 New Jersey doctors believe the managed-care system has had a negative impact on the way they practice medicine.
Four percent said it has had a positive impact and 15 percent said the impact has been neutral. Managed-care has been the health-care coverage and delivery system since the enactment of the Health Maintenance Organization Act of 1973.
”I think part of the problem is the way we deliver health care and services derogates from the quality of care patients receive,” said pediatrician Matthew Speesler, of Kendall Park, a member of the South Brunswick school board. “This is more of a problem in inner cities, but we’re seeing a decrease in care and more patients are using the hospital as their primary care provider. When patients don’t have a primary physician then they’re not getting the quality of care they should be receiving.”
The poll found that 31 percent of New Jersey doctors say they have a great deal of freedom to make clinical decisions that best meet their patients’ needs, 51 percent feel they have some freedom, and 15 percent said they do not have much freedom in making those decisions.
”The outlook will continue to be bad unless there is some reform,” said pediatrician Himanashu Patel, whose offices are in Dayton. “There needs to be a cap put on malpractice suits because you have more doctors doing unnecessary tests to protect themselves, and then you get more procedures getting rejected by insurance companies. It’s the patients who suffer under this system.”
According to the study, 47 percent of New Jersey physicians say that they charge their uninsured patients the same and 35 percent said they charge their uninsured patients less than the reimbursement amount they would receive if those patients were insured. The pool shows that 8 percent of doctors charge their uninsured patients more than what they would receive from health insurance.
”The biggest problem area where we need reform is caring for patients who are uninsured, especially for children,” Dr. Speesler said. “We need to make sure that everyone is covered and has access to quality care.”
The financial impact of managed care has hit a number of doctors, as the poll found that 84 percent of doctors said that managed care has had a negative impact on the income their practice receives. One percent said the system has improved their income and 7 percent said it has had no impact.
”I’m now paid the same amount of money today that I was paid in 1996,” Dr. Patel said. “But expenses have gone higher and medicine costs more, so we need to improve reimbursement. You have so many unnecessary procedures that do get approved, so it’s the insurance companies that get richer at the expense of doctors and patients.”
According to the study, 21 percent of New Jersey physicians said that managed care has increased the likelihood that patients will get preventive services, like immunizations and screenings. Forty-two percent said that managed care has reduced preventive care, and 26 percent said it has had no impact.
”We need to have better reimbursement in preventative care,” Dr. Speesler said. “That’s an area that suffers and we’re not reimbursed adequately.”
The financial problem has many doctors forced to make up for lost revenue by reducing the amount of time they can spend with each patient.
”What’s happening is a lot of practices are compensating for decreased revenue by increasing the volume of patients,” Dr. Speesler said. “Doctors are seeing more patients in their limited hours and can’t provide the time that each patient needs. We’re making up in volume for what we’re losing in revenue.”
The constant fight for reimbursement that doctors are involved in also is having a detrimental impact on the care they can provide.
”I’m spending 60 percent of my time doing paperwork and trying to get paid from insurance companies and only 40 percent of my time with patients,” Dr. Patel said. “It should be the other way around, at least, because I shouldn’t be spending more time doing paperwork than I do talking to patients.”
With President-elect Barack Obama promising health care reform, local doctors are hopeful that the system can be overhauled to adequately care for the needs of patients and doctors alike.
”We need to talk about reform in terms of adequate reimbursement for services provided,” Dr. Speesler said. “Insurance companies need to look at the value of services we’re providing especially in primary care without a lot of big procedures. I’d also like to see hospitals expand their services so patients aren’t waiting for hours and also have access to better facilities.”
Dr. Patel said he is hopeful for reform, but he doesn’t think major changes will occur as long as insurance companies continue to benefit.
”Reform is all talk, but there is real change needed,” he said. “Co-pays used to be only $2, but now the average is between $25 to $50 per visit. People should have the freedom to choose their own plans and pre-existing conditions should be covered. Because as it is now, the patients pay and the insurance companies benefit, and that’s not right.”

