Monday, December 27, 2010

Challenges of managed care

The movie titled, Damaged Care is based on the experiences of Physician Linda Peeno. The movie, a Showtime docudrama staring Laura Dern in the role of Dr. Peeno, is a hard-hitting representation of the practices of "managed care" healthcare by some large providers prior to 2002, the date of the distribution of the movie. The movie can be no more shocking than the real testimony of the real Dr. Linda Peeno before a Congressional committee several years ago.

In reflecting upon this I remember the book title, "No Margin No Mission," by Stephen Pearson and others. I also think of the concept, Balanced Scorecard, which is a strategic management tool. The core idea behind Balanced Scorecard is that financial and other non-financial measures each be compared in a single report. In a personal communication several years ago a management consultant in Mexico told me had never been able to earn any money by selling the Balanced Scorecard concept to managers in a variety of industries. I conclude that business schools have reinforced the management concept of maximization rather than balance. It is certainly true that without financial margin an organization cannot continue to pursue its mission. The interests of owners (including stockholders) are usually defined in terms of the greatest possible profits. The pressures of competition that would force executives into more of a Balanced Scorecard perspective does not work as well in healthcare as in some other industries. How can the profit motive and the care motive coexist in large healthcare organizations? Can these motives somehow find balance both in individuals and in large organizations in which roles produce a splitting into factions with different primary interests?

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