Why might you need your own physician advocate and a Health Advisory?

The physician under contract to your health plan is their agent, not yours. The physician who has a contract with your health plan is no longer simply working for you. He or she is for all intents and purposes a subcontractor for your plan, subject to its rules and discipline.  You are essentially under the care of the company doctor. However much the physician may want to be your advocate, there are pressures to do the minimum.

The push towards greater efficiency is leading to a pattern of practice in which primary care doctors, including internists who take care of the complicated medical problems of adults, are obliged to see four, five or six patients per hour. The reimbursement schedules of managed care plans, limited by the price at which these plans are sold, make this an economic necessity. This results in less personalized care and the use of more paramedical personnel. It also severely limits the attention which a physician can give to any individual's problem.

On the other hand, the physician who performs an independent evaluation and produces the Health Advisory is your agent, not that of the health plan. This physician will take the time needed to evaluate fully the individual's health problems and needs.

It is not sufficient to be your own advocate with regard to your evaluation and treatment under managed care. In a system weighted towards doing the minimum, it is not possible, in most instances, for an individual to realize what is not being done.

Every system has the potential for abuse. However, in the older system weighted towards doing the maximum, it was not so hard to question the need for doing tests or procedures.

The managed care model of medicine needs a safety valve, for the patient, for the physician, for the health plan, and for the employer. The personal Health Advisory provides this safety valve.

The patient can be certain that the independent health advisory is an objective assessment of personal health needs.

The physician, under pressure to do as little as is absolutely necessary, can turn to the health plan with some backup and say, "Here is what this patient really needs."

The health plan may be saved from adverse outcomes and legal liability which could have resulted from its pressure on the physicians.

The employer has implied liability by having selected a health plan and can protect itself when there are questions about care or employee complaints.

Contact DrRobinson@MD-1.com for further information.
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