Many health care concerns can be explained in more simple terms. For example, cholesterol can be divided into
the good high HDL level keeps cholesterol from depositing
the bad LDL promotes atherosclerotic deposits or plaques
the ugly VLDL - worse
Managed care has a good, a bad, and an ugly side for rural areas.
The Good
Rural Practice and Managed Care: A Success Story
Managed care in other areas of the country is driving doctors into primary care. Primary care doctors are forced to join practices in smaller cities. Whether they will go to the truly rural locations no one knows yet.
Managed care demands a more organized system of health care. Many rural areas need this higher level of organization to maintain services, retain providers, etc.
Managed care has the potential to capture patients locally that would otherwise travel out of town to other locations for care. Rural market shares vary, but about half of local patients go elsewhere even for primary care.
Rural physicians often practice the kind of care that will make managed care successful. Rural docs see more patients and do less referrals. One of the difficult thing about being an urban doctor in 1995 is trying to explain to patients why they cannot go see the dermatologist like they used to with indemnity insurance.
Managed care managed locally has the potential to capture more of the $3300 per year per person that Americans spend on health care. A county of 10,000 people could control the usage of nearly 30 million dollars although most of that would still need to leave the county.
The Bad
Centralized operations, especially those run from an urban perspective, can lead to a loss of health services in rural locations. Part of the reason for this is the efficiency of numbers. An oft-used excuse is quality. Many studies show that the more procedures done by a hospital, the better the quality. The problem with these studies is that they were done in urban hospitals on very complicated procedures like heart bypasses. Rural-based studies show that common procedures such as appendectomies, C-sections, and gall bladder operations are done just as well in rural hospitals.
Physicians who do not participate in some plans may lose patients to other physicians in town or outside the area.
Doctors are often left with the chore of explaining what managed care is during sometimes difficult circumstances.
The Ugly
Loss of services can lead to major changes for rural hospitals and those who work there.
Managed care often means changes in referral patterns. This can weaken the communication between local physicians and specialists. Patients may have to travel farther for care.
The most important part of managed care is not good, or bad, or ugly. It is you. Providers, patients, and community members will need to work to develop the health care system that best meets their needs.