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Accountable to whom?

Article Excerpt
Elementary math covers addition, subtraction, multiplication, and division. Equations and numbers confused many of us, and we questioned the value of the math exercises. As teenagers we questioned the limits our parents attempted to set on our time and behaviors. During times of sadness and grief over the loss of a loved one or a friend, we questioned God's will. At this time, as we prepare for our tax return, we question the value and wisdom of paying so much tax.

Health-care providers of both medical and mental health astoundingly are not part of the discussion of health-care's future. We challenge the intelligence of policymakers who recommend lower reimbursement rates and/or cuts in accessibility. We cleverly point out that this amounts to health-care rationing, which most find offensive. But as we look to our daily lives, we find many examples of how the lack of money disallows (or the availability of money allows) accessibility to services and products.

As Americans begin to hear even more discussions on the value of health care, we, as providers of mental health care, know firsthand that politicians and policymakers view our field as a social welfare give-away program with little value other than making patients feel good for a short time. The point, however, is really about accountability.

Politicians justify our taxes for the building and maintenance of highways; the protection of National Parks, the payment of our federal government, state government, homeland security, and military; the promotion of research through organizations such as the National Health Institute; the education of our children, and the availability of public health care. Just as politicians are accountable for the money spent on these and other services, the government and managed-care agencies are asking health-care providers to offer more accountability for their services to justify current or anticipated future reimbursement rates.

In health-care graduate schools, we were taught that the patient comes first (Do No Harm). In today's marketplace, we are being taught that the patient is not even second!

The introduction of managed care as the primary tool for controlling industry costs has intruded upon the relationship Americans have with their health providers. If money controls access to the best health care practice and treatments, then those with little-to-no money have little-to-no access. Many providers are now turning away from insurance plans, including Medicaid and Medicare, because reimbursement rates are so low that they can no longer meet their overhead expenses. Rationing benefits and services/treatments affects not only the patients, but also the providers.

When starting a practice, it is hard to find a more drastic change in direction than shifting the focus from the patient to keeping the business afloat. When we have to spend more time taking the steps necessary...