Our society is engaged in a great effort to reform the health care payment system. There used to be only two "players" in the system: the doctor and the patient. Now there are several others: the health insurance industry, various federal and state regulatory agencies, employers (who often provide employee health care plans) and the federal government. New rules and regulations are being proposed and implemented that will change the basic concepts and practices of health care.
The patient's need for skillful, dedicated and considerate care by the physician has never changed. From the viewpoint of the physician—now called a health care provider—what has changed is that there needs to be interaction with other parties and agencies that have taken over some of the decision making that used to belong to the physician alone. Many decisions now need outside approval. These include the decision to hospitalize, where to hospitalize, which consultants may be called, what types of treatment may be used and, especially, how health care resources are to be allocated and provided. Authorization required to order tests and x-rays is just one example. Many doctors' offices now have more people handling insurance than they have nurses. Physicians will need to be increasingly accountable to outside agencies.
"Managed care" is one common expression for a coordinated effort by physicians, hospitals and insurance payers to work together to create an optimum balance between incredibly sophisticated medical technology and our inability as a society to afford paying for every possible test and treatment while looking for every possible diagnosis for each person in every situation. The "practice guidelines" now being developed will probably become increasingly important in how services are provided and covered.
