Wednesday, March 02, 2005

Managed Care: The Reality

Managed care advocates claimed it would improve quality and reduce costs. Here are two more examples of the reality which proved to be something a bit different.
In today's Boston Globe, an article about increasing be shortages among Boston area hospitals. "By the 1990's, many healthcare specialists predicted that managed care insurance companies would restrict overnight hospital stays well into the future. So, hospitals mothballed beds, and some shut down entirely."
I remember all those predictions. I also remember wondering how managed care would wipe out so much disease that the demand for hospital beds would fall so much. After all, most people go to the hospital because they are sick. Of course, managed care didn't wipe out so much disease...
In today's New York Times, an article on the looming Prilosec shortage. Prilosec is now available over the counter, and demand for it is outstripping supply. Prilosec OTC is much cheaper than Nexium (both made by AstraZeneca), but molecularly, they are mirror images, and there is no evidence of which I am aware that Nexium produces better clinical results, despite all those ads for the new "little purple pill," funded by a massive Astra Zeneca marketing effort (worth US $260 M in 2003, the last year for which data were available.) Compounding the problem is that managed care rarely will pay for perscription Prilosec, which is generally available, because an over the counter version exists. Instead, the same insurers seem willing to pay for much more expensive Nexium.

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