(May 2001)
The Chapter takes a strong stand in Warning: Managed Care May Be Hazardous To Your Health. The Report, issued October 2000 is based on over 300 reported cases. The Managed Care Critical Incident Reporting (CIR) Project has been collecting significant managed care difficulties from health/mental health consumers and practitioners since 1998. The Project remains committed to providing a much needed loud collective voice to state officials that the for profit managed care health industry is having devastating effects on all aspects of health care.
The Report reflects social work's key role in mental health treatment and advocacy. Chapter members have been the crucial force behind the success of the Project. Independent practice members provided much needed seed money during the Project's inception; and, social workers across the broad spectrum of social work practice, returned completed CIR reporting forms. These social workers have insured that the voice of the consumers is present. Consumers account for roughly 50% of the returns.
The CIR Project is a joint effort of the Chapter's Health Care Policy and Practice Network and the Independent Practice and Managed Care Task Force under the auspices of the Managed Care Committee. The Chapter Managed Care Advisory Committee is central to the continuation of the CIR Project.
Members are Jerry Beallor, Barbara Brenner (committee chair), Mona Dreier, Terry Mizrahi, Marcia Poston, Alicia Sainer, Jane Salchi, Penny Schwartz, and Dava Weinstein.
Advocacy organizations have uniformly welcomed Warning: Managed Care May Be Hazardous To Your Health. The Report supports the ongoing work in the City and in Albany. The Report repeatedly points to a much-needed alternative to self-regulation (a.k.a. the fox counting the chickens) by the managed care industry.
Warning: Managed Care May Be Hazardous To Your Health and its predecessor, How Healthy is Managed Care? (released in 1999) support calls for additional legislation and a statewide, government based, regulatory structure for holding companies accountable. The damaging impact and hazard posed by managed care to health/mental health consumers, small community based agencies, the large hospital, and the independent mental health practitioner is firmly established.
The Report documents the absolute necessity for social workers and all health team members as well as medical consumers to know the law or have access to persons who know the law as it relates to health care. NYS's Managed Care Bill of Rights is decent legislation IF practitioners and consumers know it and use it to advocate for adequate health care.
Consumers and medical practitioners completing the form provided many dramatic examples of compromised health/mental health care. Social workers in every area of practice documented numerous examples of denied, limited, or inadequate care. Some denial of access to care is blatantly contrary to the law such as consumers being misled to believe that they need prior approval for emergency room care.
Other reports document real problems with accessing specialty care. A sample of the horrific incidents reported include:
Warning: Managed Care May Be Hazardous To Your Health was the focus of a meeting the Chapter hosted on November 28, 2000 with leaders of health and legal advocacy organizations. Barbara Brenner chaired the meeting and was joined by other Chapter Managed Care Advisory Committee members, representatives from Citizen Action of New York, Community Service Society, GMHC, Health Care for All Campaign, Medicare Rights Center, and NYS NASW. Our Chapter's commitment to accessible quality health care was evident with executive director Dr. Bob Schachter, Harriet Putterman, political coordinator, and Dr. Eunice Matthews, third vice president in attendance.
Warning: Managed Care May Be Hazardous To Your Health was used as a springboard at that meeting to plan to work cooperatively towards shared goals in the present legislative year. It was agreed that New York's health care is in a state of crisis. All organizations at the meeting agreed that it is imperative that a statewide ombudsman program be established to help consumers and medical providers navigate the unwieldy system. It is imperative that state government monitor the managed care industry and hold companies accountable for their business practices. It is imperative that legislation protect the consumer's right to sue a managed care organization.
The Managed Care Advisory Committee continues its efforts at improved health care through meetings with various state officials responsible to New Yorkers. We are always working with like-minded organizations to see to it that every effort to secure needed changes in the managed care industry are made. You can continue to help in these efforts by returning Critical Incident Report forms. Forms may be completed electronically (www.naswnyc.org) or you can obtain hard copies or by calling the Chapter 212/668-0050 ext. 200. The full text of Warning: Managed Care May Be Hazardous To Your Health is available at www.naswnyc.org/mc37.html.