When I started in medicine, doctors and patients discussed treatment and therapy with a tacit acknowledgment that the patient was responsible for 20% of their bill, barring supplements. There was minimal insurance or medicare involvement, and for the most part, there were few regulatory requirements for pre-approval of therapy. The doctor-patient relationship was between the patient and the doctor.
Beginning with the Clinton Health Care reform of 1993, which was not passed, incrementally regulations were enacted that allowed medicare to approve only particular therapies, that were developed by blue ribbon panels chosen by the government. Some of which were based on RCT (randomized controlled trials), but a large number were based on the economics of the medicare trust fund and statistical gymnastics to treat the most people for the lowest cost while minimizing the best treatment that may not be the most economical. By assigning benefit payments from medicare to doctors and hospitals, the contract allows a review of possible therapy and directs the hospitals and doctors to specific therapies that are approved as above.
This concept continues today, whereby accepting benefits from either government programs or insurers allows the payor to direct therapy.
Medicine in the 21st Century
When I started in medicine, doctors and patients discussed treatment and therapy with a tacit acknowledgment that the patient was responsible for 20% of their bill, barring supplements. There was minimal insurance or medicare involvement, and for the most part, there were few regulatory requirements for pre-approval of therapy. The doctor-patient relationship was between the patient and the doctor.
Beginning with the Clinton Health Care reform of 1993, which was not passed, incrementally regulations were enacted that allowed medicare to approve only particular therapies, that were developed by blue ribbon panels chosen by the government. Some of which were based on RCT (randomized controlled trials), but a large number were based on the economics of the medicare trust fund and statistical gymnastics to treat the most people for the lowest cost while minimizing the best treatment that may not be the most economical. By assigning benefit payments from medicare to doctors and hospitals, the contract allows a review of possible therapy and directs the hospitals and doctors to specific therapies that are approved as above.
This concept continues today, whereby accepting benefits from either government programs or insurers allows the payor to direct therapy.