Here is a little boring background for the following outlook.
Bear with me... :)
I began working in the hospital setting in 1976 when healthcare was gradually working toward utilizing the Diagnosis Related Group system (DRG) for billing purposes, which consisted of using the diagnosis codes for pricing; codes previously had primarily been utilized for indices (research).
This was when the Federal Government started to take control of the way Medicare dollars were spent, forcing the beginning of the practice of "cookbook" medicine; i.e., physicians had rules on what treatment they should render for certain diagnoses.
This was finally implemented around 1984.
Gradually insurance companies started utilizing similar plans for their payments.
In the late 80s and 90s insurance companies got on the band wagon and negotiated and made deals with hospitals, Doctors, Home Health Practices, etc. for each DRG, according to the amount the insurance company was willing to pay, and they each had their own rules about what treatments, etc. would be reimbursed for in each diagnosis -- this is when we started seeing HMOs and PPOs.
I retired in the late 90s and am on Medicare and supplemental Health Insurance; I have noticed that very subtly the insurance companies started opening (taking over/buying out) diagnostic centers, hospitals, physician's groups until they now have the whole ball of wax--seems like we have the fox not only in the hen house, but raising the chickens.
Medicare patients are given so many CT scans, Ultra Sounds, xrays, they cannot even keep tract of them..and these procedures do not come cheap..
Granted, I feel this probably is a good thing for the patient, however, I believe that there are a lot of unnecessary procedures done and that the insurance companies are loading up off Medicare....
Not to mention prescriptions for expensive drugs -- that, I know is not a good thing -- don't get me started on this...
Utilizing extensive endocrine studies (i.e., lab tests for blood, urine, etc..) initially, would probably cut down tremendously on the $ spent; as well as determining more specific and accurate diagnoses.
How did this happen??? Who, in their right mind, would allow the insurance companies, not only to make the rules, but to take over the facilities that were formerly the watchdog between Federal $ and the greedy insurance companies?
I have not read one word, or heard one thing in the media about this....????
The following article alludes to the beginning portion of my experience.
http://www.naturalnews.com/033881_health_care_profits.html
