An article taken from Dentistry@Stat.com

I think the concept of managed care has become bastardized because some people just got greedy. We tried Prudential DMO and Cigna for eight months and found that the bottom line fell way short of my expectations. We found that our paperwork increased about 40%, the enrolled patient participation rate was 64%, and the payback was peanuts despite having negotiated above average compensation rates.

As I see it, with fee for service and indemnity insuance, the financial risk is on the patients and/or their affiliated indemnity insurance company. With managed care plans, most of the risk is on the health care provider; we're financially re-inforced for not seeing patients. If you are guided by ethics/values then MC runs contrary to such principles.

I want to take care of my patient's dental health needs. Managed care advocates use a guise of "prevention-oriented" care as rationale/sales tactic, but what it really boils down to is money-money-money. I could make a lot of money with managed care plans if I cared more about money than I did taking care of my patients. As such, I felt my alternative were to work 3-4 times as hard to make almost as much money as without managed care or just dump my participation in such plans and work to improve my fee-for-service practice.  

It would not be fair if I didn't also mention the other side of the coin. Again, greed being so pervasive in our society, there is certainly a problem with overtreating patients as well. The potential for overtreating and undertreating patients is prevalent in both managed care and fee for service scenerios.

Fixing the problem is complicated because it involves changing the mind-set of everyone- health-care providers, insurance companies, drug and supply companies, patients, indeed everyone. We, as health care providers must start with ourselves as individuals and develop a personal "prime directive" or mission statement, representative of proper values. From that "proactive focus", our decisions and actions should be determined- not by the conditions in our lives or by others. We must also consider it our responsibility to educate others in this same vein.

Fasb