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Hospitals
and Insurers Try Flat Fees - Again |
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Caritas and Blue Cross say this time they'll build in
safeguards to prevent the problems of managed care
| by Catherine Arnst |
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Managed
care, that much maligned symbol of greedy insurers and
lousy health care in the 1980s and '90s, is coming back.
This time, though, its advocates swear they can get it
right. |
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Consider
what is happening in New England. Blue Cross Shield of
Massachusetts, that state's dominant insurer, and
financially struggling Caritas Christi Health Care, its
second-largest hospital network, want to switch from a
system that charges patients for every medical service
to a managed-care-like flat fee per patient. The yearly
fee would be adjusted for age and illness. |
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Dr. Ralph de
la Torre, the newly named CEO of Caritas, believes
charging patients a flat fee - to be paid, ultimately,
by the insurer - will allow him to offer cost-efficient
care with an emphasis on preventing illness. Such an
approach will distinguish his six smallish medical
centers from the many large teaching hospitals in Boston
that levy fees for every visit, test, and medical
procedure. For its part, Blue Cross Blue Shield hopes to
halve growth in medical spending within a year by
hospitals and doctors who accept flat-fee
reimbursements, according to Andrew Dreyfus, who heads
the insurer's health-care services. |
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First,
though, they have to overcome managed care's horrible
reputation. Usually provided by a health maintenance
organization, the approach was widely rejected by
patients who felt they were denied care when it was
deemed too costly. This time, Caritas and Blue Cross say
they will build in safeguards to make sure flat fees are
fair to both patients and doctors. |
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