Word: hmos
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...diet-drug revolution is facing a backlash. Some of the nation's largest HMOs, including Aetna U.S. Healthcare and Prudential Healthcare, have begun cutting back or eliminating reimbursement for both pills. Diet chains like Jenny Craig and Nutri/System are backing away from them too. Several states, meanwhile, have restricted the use of fen-phen. Last week the Florida legislature banned new prescriptions entirely and called on doctors to wean current patients from the drug within 30 days; it also put a 90-day limit on Redux prescriptions. Even New Jersey doctor Sheldon Levine, who touted Redux last year...
...managed care only because Indiana has been among the states slowest to require it. Its economic good fortune will change, they say, when the two automobile companies with large plants in Bedford start requiring employees to shift to managed care and when Medicaid and Medicare begin pushing recipients into HMOs. At that point, if Dunn is to survive, it may have to sell out to a large for-profit chain. Should that happen, Bedford's medical civil war will simply rage on with even greater firepower...
After a decade of grim headlines about spiraling hospital bills and shifty HMOs, the boom in self-medication comes as no surprise. "People are fed up with the high costs and side effects of drugs," says Earl Mindell, a registered pharmacist and author of Secret Remedies (Simon & Schuster, 1997), a new study of the self-care movement. "We're doubling our knowledge about nutrition every 18 months. So people wonder, instead of treating the symptoms as we've always been taught, why not help your body fight off the problem in the first place...
...most American lives a managed-care plan will someday come--along with voluminous and bewildering packets of information supposedly designed to let the patients know what sort of health care they can expect. But how to choose? Some organizations, and even some popular magazines, have attempted to rank the HMOs, but their various methods of scoring are at cross-purposes--and may have little to do with the quality of care. For starters, some HMOs have simply declined to participate in these surveys or submit to the accreditation process established by the nonprofit National Committee for Quality Assurance. Moreover...
...HEDIS, a set of criteria for evaluating an HMO that lists more than 100 points of comparison, ranging from "childhood immunization" to "ambulatory follow-up for major affective disorder." But HEDIS, with its emphasis on preventive care, is easy to manipulate. When cholesterol tests became a key criterion, HMOs scrambled to offer the tests--often with no follow-up on the patients' results. Most experts agree that it is much more useful for a patient to know the breast-cancer survival rate in a given plan than to know whether it offers free mammograms...