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Reply by Abendroth to Kator on "Clueless in the Land of Managed Care"

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December 19, 2000

Abendroth's reply to response by Megan Kator to letter to the Editor by Abendroth on Clueless in the Land of Managed Care  by Anonymous Physician (January 6, 1997)

Susan Abendroth's Reply:

Ms. Kator has misunderstood my original point. I did not assert that health care be viewed strictly as a business. Quality and cost containment can, and usually do, go together. But the business aspects of a payment system have tremendous influence on the way the system works.

There are several different ways of organizing a healthcare payment system that fall under the general heading of "Managed Care". These systems are generally contrasted with the fee for service payment model. Any system of payment for limited resources is going to have critics, because each way the system pays for care will have effects on each of the three "parties to care" - patients, providers or payors. I stand by my assertion that many critics of managed care are not knowledgeable about important aspects of each payment model. This lack of understanding leads to mistaken conclusions about what is causing the outcomes seen.

As far as Ms. Kator's criticisms of the Canadian system go, I agree they have problems. The also have basic care available to most citizens at much less cost and provide better quality of care by most accepted international measures. Further, I wonder if anyone here or there is ready to pay the cost of "the best health care" for all citizens....if we could even agree on a definition of what constitutes "the best health care". There are different methods of rationing and I happen to believe Canada's method is better than the U.S.'s. We will probably have to agree to disagree, because values play such an important role in these discussions.

Susan Abendroth, RN, BA