Medical providers have both the right and the obligation to prescribe what they believe, in their professional opinion, are the right products, services or solutions for their patients. That’s why medical professionals are highly educated, licensed and regulated. Any insurance or quasi-insurance plan that directs patients to specific products, services or solutions independent of the provider’s recommendation is in fundamental conflict with the provider, and by extension, the best interests of the patient. Any plan that provides incentives to providers to use particular products, services or solutions is establishing a fundamental conflict of interest between what’s best for the patient and what’s best for the plan. That’s one reason why the pharmaceutical industry has been forced to eliminate all such incentives through the PhRMA regulations established in 2009.
The case might be made that such situations are no different than those of an insurance firm directing the use of a generic drug vs. a name brand. Such direction might be fair game, when the products have no difference. However, even in those instances, the doctor is a) not compensated directly for prescribing the drug and b) has free will relative to his prescription.
Providers have a sacred responsibility to deliver both the best medical care and the highest possible quality of vision. With vision, I don’t believe that adequate is acceptable just as I wouldn’t want to be prescribed a drug that almost does the job if there exists a better alternative. In today’s high technology world, there is no such thing as a generic lens or frame. There is only that product which is in the best interest of the patient. Should the patient choose something other than that which is prescribed, that is the patient’s right. But it’s the provider’s responsibility to educate the patient as to the differences between products.
In my opinion, insurers who provide financial incentives to direct either patients or providers to specific products relegate the participating provider to the status of merchant. From that point, there’s no reason for the plan not to deliver such products directly to the insured, eliminating the providers involvement altogether. That train has already left the station.
Providers who participate in such plans are devaluing their own services and fueling their ultimate elimination from the eyewear distribution channel.
