and hospitals. Other ways of saving money further reducing hospital stays, restricting patients' access to specialists and expensive medical tests, limiting patients' choice of physicians are ones patients are coming to hate.The Change in Patient CareMost Americans used to have fee-for-service health insurance, where patients can choose their medical service provider and the insurance company pays a percentage of the fees, after a deductible. This creates various financial incentives: for patients, to see a doctor only when absolutely necessary; for doctors, to provide more tests and treatments rather than less. In managed care, patients pay vastly reduced fees to see their "primary physician" but they can't see specialists or other medical service providers without their primary physician's approval. For patients, the financial incentive encourages casual doctor visits for such things as preventive care, but makes it almost impossible to choose medical options not approved by the primary physician. And for doctors, watched over by plan accountants, the incentive encourages minimum tests, referrals and hospitalizations. Both systems have their advantages, and no consensus exists amongmedical researchers about whether consumers are being served better or worse in the managed care environment than they were in fee-for-service....
