Health Care Rationing through Inconvenience

Many strategies for the containment of medical costs have emerged from systems of managed care — gatekeeping by a primary care physician, prior authorization and utilization review, assumption of financial risk through capitation payments to the provider with financial disincentives for hospitalization or referral to specialists, and so forth. But another feature has crept into the managed care formula and has been largely overlooked: that of slowing and controlling the use of services and payment for services by impeding, inconveniencing, and confusing providers and consumers alike. In managed care's arsenal of cost-control weaponry, probably none is more potent — except . . .