Throughout the United States there has been an overwhelming concern as
to the status of the present health care system. Approximately 100,000
people lose their health insurance each month. Unfortunately the present
system does little to nothing to aid these people. It is for this reason
that various managed health care plans have come into existence and use.
Managed health care is a system by which an outside body, such as a state
or federal government places regulations on the health care process.
St. Luke/ Roosevelt Hospital in Manhattan is currently operating under
a managed health care plan. Vickie Powell, In-patient Pharmacy Supervisor
at St. Luke/ Roosevelt states that the approach to managed care in the
hospital involves a “Gatekeeper” mechanism. According to Powell each
patient is assigned a gatekeeper, a general practitioner who will decide if
the patient is in need of a specialist. If so the gatekeeper will make a
referral to a specialist. Providing the patient chooses to follow the
gatekeeper’s referral he or she will be granted the health care benefits
covered under the managed health care plan. If they are to go against the
referral and see a doctor not recommended they do not receive the coverage
that they would under the plan.
When asked how this would affect the pharmacy aspect of the hospital
she said “Pharmacy must become involved in the schooling of the patient
about the medicine, where this was previously the job of the nurse.”
Besides this she says it would not have a great effect on her department as
opposed to the hospital as a whole.
Managed health care plan that has received the most publicity is that
of President Bill Clinton. Clinton’s plan calls for universal health
insurance, meaning that no one could be denied coverage. When faced with
the question of what happens to now coming into the hospital without any
health insurance. Powell said, “A person can’t be turned away from the
emergency room with or without insurance. This causes a large deficit for
the hospital.”
One of the major problems that most critics see with Clinton’s plan is
that it attempts to provide universal insurance without placing limitations
on who can receive certain types of care. These limitations are present in
the European, and Canadian plans that Clinton’s emulates. An example of
such a limitation is dialysis treatment. In the other countries only
people under the age of fifty are eligible for coverage on this expensive
treatment.Ms. Powell does not see any way that the Clinton plan could go
into effect without implementing such limitations.
Although the vast majority of Americans see a need for reform in the
health care system there are several areas for the reform that they are
asking for. The reforms can be made on the hospital level, like the plan
of St. Luke/ Roosevelt or as large as the national plan proposed by
President Clinton. Ian Blumenfeld
