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For Patients' Sake, Insurance Companies Urgently Need a Code of Conduct
Date:4/28/2009

ENCINO, Calif., April 28 /PRNewswire/ -- Managed care companies are the only sector of the health care industry lacking a code of conduct. It is time for that to change.

(Photo: http://www.newscom.com/cgi-bin/prnh/20090428/PH06755)

Recently, the American Medical Association (AMA) drafted language for a National Health Insurer Code of Conduct. The code's four key principles are: clinical autonomy, transparency, corporate integrity and patient safety and welfare. I commend the AMA for drafting this code. Unfortunately, the health insurance industry has been silent on it.

Why is this code of conduct so important? Financial incentives -- not patient welfare -- are the driving force behind insurance operations.

A survey by the Medical Society of the State of New York showed that more than 90 percent of physicians indicated they had to change a patient's treatment -- or medication -- based on restrictions from insurance companies. A survey by The Toledo Blade of members of the Ohio State Medical Association and the AMA revealed that 95 percent of respondents said insurers interfered with decisions about prescriptions, 91 percent with testing, 74 percent with referrals and 69 percent with hospitalization decisions.

Every day insurance companies challenge physicians' authority and expertise. Studies and my personal experience reinforce that. This problem is particularly acute as insurance companies and pharmacy benefit managers seek to dictate a particular medication to prescribe. Insurance formularies and other barriers to specific medications make it difficult for doctors to prescribe the medication they deem the most appropriate.

In the worst cases, unauthorized drug switching occurs. That's
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SOURCE National Minority Quality Forum
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