Vested Interest
Buyer Beware: Car Salesmen, Doctors.
Everyone knows to beware of a good salesman, especially when making major purchases like a car or house. The reason for concern stems from the perceived level of objectivity of the information being considered. Presented with a perfect stranger seeking to make a one time commission, the buyer is concerned that the salesman’s vested interest is making the most profitable sale rather than best value and match for the buyer. The bias of the sales person toward his own interests creates a situation characterized by misinformation and can result in erroneous and harmful decisions being made. The same phenomena can occur within the field of health care research if the selected methods and population samples of a study have not neutralized the possible bias of those administering it.
If providers and payers continue the trend of the last 30 years and merge into fewer but larger group organizations and as such inherit more market power, should health care consumers be concerned about possible bias, when confronted with formularies, best practices and clinical guidelines developed by these organizations? In order to determine whether or not the characteristics of the individuals making up a group influence the outcomes and conclusions of formal consensus amongst health policy makers, Hutchings and Raine conducted a large meta-analysis of 52 different studies. The data was collected by executing designed searches of various medical databases such as MedLine or PsychInfo. For inclusion into the meta-analysis, studies had to use one of three formal consensus methods (NGT, Delphi, or RAND/UCLA) and differentiate the two groups or individuals based on their characteristics and perceived level of appropriateness for whatever treatment being considered. After the data…
Three Words, One Circus; Medicare Open Enrollment.
Three words, one circus; Medicare open enrollment. On the surface, the goal seems simple enough: provide health care services for senior citizens and those who are permanently disabled. Subcutaneous exploration reveals a dark labyrinth of confusion, full of dubious pitfalls and misinformation, with little explanation for those who take time to seek it. Every year most Americans go shopping for health insurance, they call it open enrollment, and for working people who receive benefits through their employer based plans, a lot of the shopping has already been done. Still, many people find it very confusing and difficult to think through the limited amount of decision making they are left to make. Seniors have it worse; they don’t have a human resource department with trained people to make decisions; they have to do it all themselves. Making it worse, insurance companies that provide medicare benefits have to market their products to individuals like any other product, sell sell sell. Now, if seniors were well informed and companies always acted with integrity the environment might not be as threatening, but the current system has created exactly the opposite situation, and plenty of companies try to take advantage of trusting, ill informed Medicare enrollees.
Over time, many managed care organizations have carved out specific benefits to other organizations. For instance, most people have a vision plan, a dental plan, etc. Medicare is no different. The one benefit that has been carved out but is just a little different in nature than the others is the pharmacy benefit. The dental plan wants you to have great teeth, the vision plan wants your eyes to be fine. It’s in their best…
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