Eagle Eye Contents

The future may be more choice, lots of options — but you’ll pay more.

For well over 10 years we have loved to hate Managed Care. Playing by the rules of the HMO’s has become a way of life. Whether you are the patient or the provider, access to specialty care has been restricted, waits for treatment extended and if you didn’t follow the rules, oh boy!

But now the days of tightly controlled managed care may be coming to an end. The new world of health care will offer more choice: you’ll pick your own doctors and hospitals and have more say over which drugs you get. But you will also probably pay lots more. Health care choice at a price.

The health care market is evolving to products that aim at giving consumers a financial incentive to seek care only when they need it and to think twice before running to the doctor at the first sniffle.

Roughly half of all workers spend less than $600 a year on medical costs. Health care costs nationally are expected to rise over 12%in the next year and employers are expected to shift more expenses to their workers.

Consumer driven or defined contribution plans are getting all the attention, trying to encourage workers to become more active in choosing where to go and paying for those choices. An example is your employer contributes $1000 to your health account. You have an annual deductible of $1500. The first $1000 of expenses you have no out of pocket fees. The next $500 you pay every cent. You then share in the next $2000 with your employer. After that the insurer picks up the tab for catastrophic illness. You can see any doctor but the plans are built around a network and you can save by using a doctor who has negotiated lower fees. Web sites will allow you to track your spending habits, compare the costs of local doctors, and get consumer ratings on doctors and hospitals. They will also provide medical information and personal advice from a nurse. In some market places, insurers will give the employee the choice of customizing their own networks, building a list of specialists and hospitals. Co payments for office visits, drug benefits and even hospitals may be tiered based on the specialist, generic or name brand drug, community or teaching hospital.

These types of plans will force employees to pay as much attention to buying treatment as they do buying a car. The winners will be those who spend the time, money and energy to get the best care.

In the post-HMO world you’ll have to learn more about how to take advantage of the advances in medicine and you’ll probably also pay more for them.