Editorial: Bean counters lose, but patients win one

Tuesday, Nov. 9, 1999 | 9:14 a.m.

Health insurers have fought government requirements that doctors -- not HMO accountants -- make the final judgment on patient care. An underlying principle of managed care is that doctors, if left unchecked, will prescribe unnecessary and costly medical care. So HMOs have allowed their managers to overrule doctors on medical decisions.

It was shocking, then, when the nation's second-largest health insurer announced Monday that it now will give doctors the final say on what care is necessary. What is fascinating is the reason behind this radical change: costs. UnitedHealth Group had found that it was wasting $100 million annually to get prior approvals. Since the insurer approved 99 percent of the requests anyway, the paperwork cost more than the money that was being saved. Doctors still will have to justify some costly tests and other procedures, but ultimately the physician will have the last word on the patient's treatment.

Managed care's dark side, which puts profits above patient care, has been disastrous. It is hoped that other insurers follow the lead of UnitedHealth Group. After all, making money and doing what is morally right don't have to be mutually exclusive.

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