As increasing numbers of people are herded into managed care programs,
they find administrators and green eye-shade types shaping many of the
treatment decisions that used to be made by a primary care physician.
At a recent meeting of Western state legislators in Santa Fe (U.S.),
one health care analyst explained the problem with a story. It went
something like this:
The president of a large managed care facility also served on the board
of the symphony orchestra. When he could not attend a scheduled
concert, he gave his tickets to one of his colleagues, his health-care
cost containment director.
The next morning, the president asked the cost-containment director
how he enjoyed the performance. Instead of a casual, polite remark, the
director handed the president the following memo:
"I appreciate the free tickets to the performance of Schubert's
"Unfinished Symphony" by our city's symphony orchestra.
But, as your cost-containment guy, I was appalled by clear evidence of
waste. It's no wonder you have to spend so much time fundraising. Let
me share with you my observations and offer some recommendations that
might help you improve the efficiency and productivity of the symphony.
"First, the attendance of the conductor is unnecessary for public
performances. The orchestra has obviously practiced and has the prior
authorization from the conductor to play the symphony at a
predetermined level of quality. Considerable money could be saved
merely by having the conductor critique the orchestra's performance
during a retrospective peer review meeting.
"Second, for considerable periods, the four oboe players had nothing to
do. Their numbers should be reduced and their work spread over the
whole orchestra, thus eliminating peaks and valleys of activity.
"Third, the twelve violins were playing identical notes with identical
motions. This is unnecessary duplication: the staff of this section
should be cut drastically with consequent savings. If a large volume of
sound is required, use new electronic amplification technologies which
are capable of very high levels of reproductive quality.
"Fourth, much effort was expended playing 16th notes or semi-quarters.
This seems an excessive refinement, as most of the listeners are unable
to distinguish such rapid playing. I recommend that all notes be
rounded to the nearest eighth. If this were done, it would also be
possible to use trainees or lower grade musicians with no loss of
"Fifth, no useful purpose would appear to be served by repeating with
horns the same passage that has already been handled by the strings. If
all such redundant passages were eliminated, as determined by a
utilization review committee, the concert would have been reduced from
two hours to about 20 minutes, resulting in substantial savings in
salaries and overhead. In fact, if Schubert had addressed these
concerns on a cost-containment basis, he probably would have been able
to finish this Symphony!"
Almost anyone who's been to a managed care provider knows from
experience that "customer satisfaction" isn't a high priority for an
industry that hasn't worried much about its customers. The time to
change is now, and those who do will win in the marketplace.
Author: Philip M Burgess