MANAGED CARE REQUIRES DOSES OF REALISM, COMMON SENSE

When it comes to health services, managed care is uppermost on the minds of both those who deliver medical care and those who are in need of medical care. Although it is a complex topic, managed care in its simplest form caps the charges for medical care in an attempt to hold down costs.

In general, managed-care options have been slower to develop in the Cape Girardeau area than in other parts of Missouri and the nation. Cape Girardeau is an important regional center for medical services, with two hospitals and dozens of doctors who specialize in virtually every aspect of modern medicine.

One reason that managed care has taken longer to develop here is because the providers have consistently given top-quality care at competitive prices. But, as the new president of St. Francis Medical Center observed recently, managed care is a reality, and the hospital he administers must be ready for it.

Managed care "forces people to be restrained in the amount of resources used," Sexton said in an interview with the Southeast Missourian. But there is a natural resistance, in some measure, to a medical-delivery system that is frequently viewed as medicine-by-bureaucracy by patients as well as doctors and hospitals.

Indeed, bureaucratic administration of health care has been the target of legislative inquiries in Missouri -- hearings that are likely to show up in various legislative proposals in the weeks ahead. Last year, for example, the Missouri Legislature passed, and Gov. Mel Carnahan signed, a bill that lengthened the minimum stay for women who have babies.

There is a fine line between appropriate controls on the cost of medical systems and bureaucratic overkill. In recognizing the need to be ready for managed care, the new top official at St. Francis Medical Center is taking a realistic point of view. This readiness will include the hospital's ability to negotiate fees that are fair to the hospital, patients and whoever pays for the hospital stay, which in most cases is private insurance or Medicare.

If an appropriate balance can be struck without legislative interference, everyone involved is likely to be better off.