Future of Managed Care

[andrew.maiorini]

Interested in what everyone thinks will be the implications for managed care if some form of government run Universal care is implemented. I do not intend to get too political with this post. Just interested in what may be the pros and cons as far as we are concerned in the managed care business. At this point it seems almost certain that there will be more government involvement in healthcare in the very near future.

[Nochmar]

If we become a more socialized medical system, I think our responsibilities could change dramatically. What I see as the most likely changes are:

1. The establishment of a government run/sponsored economic evaulation of therapy, similar to the way the English use NICE; however, their opinions won't have such a dramatic effect. They would have more of an effect on Medicare and perhaps Medical Assistance lives than on the private sector.

2. Big pharma will likely spend less on product development or their research will gravitate to areas which provide less oversite or greater reimbursement potential. They will make their desired margin one way or another; cutting research cuts costs; they would opt to buy products from smaller companies to market more drugs.

[participant1]

The question everyone should think about is - if we do end up with universal healthcare, who's going to pay for that?? I know many people who would say that they don't feel like paying for someone else's insurance, especially when there are some 44 million people in that boat.

And anyway, I don't think we'll ever get to universal healthcare in this country

[DirPharmPubEmp]

The best review of the twin issues of access and cost that I have seen recently is, "The 'Inconvenient Truths' about Health Care", by Vincent Fuchs, Professor Emeritus of Economics at Stanford. It is dated 10/23/2008 and you can read the full text for free at NEJM.ORG (its on the home page).

[SarahK]

There was also a good analysis of the two candidates' health care "reform" plans in the October issue of Health Affairs.

[diana.papshev]

I think that it's all about the model.

Providing healthcare coverage for all Americans (ie, universal healthcare) does not require the nation to move to the socialized medicine model. It could still be done through the private market, where managed care can play a big role, with Medicare being the perfect example. In fact, I think the physician, hospital, and managed care advocacy is way too strong for us to go to a single payer model.

There are many possibilities for creating universal coverage and the ones that look the most realistic, from my perspective, should definitely boost the managed care business.

[andrew.maiorini]

This WSJ story was a bit concerning. This would definitley impact the industry..

http://online.wsj.com/article/SB122619608624911395.html.html

[chantell.reagan]

On a related topic, Carl Bertram, PharmD posted a poll on LinkedIn asking for opinions on whether the US government will pay for prescriptions in the next 8 years. More than 150 managed care and healthcare professionals voted, and roughly two thirds did not think there will be universal drug coverage sponsored by the government. The remaining one third believed that all US citizens would be covered by the government within 8 years with a standard individual patient copay for prescription drugs.

View poll results (Note: link may require LinkedIn login-in)