Word: hmos
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...coalition is apparently heartened rather than daunted by the fate of two propositions to regulate HMOs that appeared on last November's ballot. Both lost but drew about 40% of the vote--even though supporters of one measure were outspent nearly 50 to 1 by their foes. The more restrictive of the two measures, significantly, was drafted largely by the California Nurses Association. Nurses fear that HMOs want to squeeze them out of many jobs and replace them with low-paid technicians...
...major goal of many patients' groups is to compile report cards showing how HMOs stack up against one another. The patients are getting some help from employers such as the 33 giants that have formed the San Francisco-based Pacific Business Group on Health. P.B.G.H. has set up an online facility, on which the nearly 3 million employees of its member companies can swap stories about how well or how badly they have been treated by managed-care plans...
...Clinton Administration is issuing a stream of thou-shalt-not orders to HMOs that sign up Medicare patients. The latest prohibits quick in-and-out mastectomies. Others forbid HMOs to limit what doctors can tell Medicare patients and restrict their ability to pay bonuses to doctors as a reward for keeping costs down. This regulatory club has power, since HMOs rate signing up Medicare and Medicaid patients as their best prospect for expansion...
Executives, meanwhile, feared they would lose control of health-care costs. In Minnesota as elsewhere, HMOs are merging at such a pace that some analysts think the three that currently have 78% of the business will soon have all of it. They "would own all the doctors and hospitals and could charge us whatever they wanted," says a company official. Well before things got to that pass, companies' premium bills were rising rapidly, and no one could quite explain why. "We were writing checks into a system where we didn't know what we were getting for services in return...
...couldn't these incentives tempt doctors to give patients the cheapest rather than the best treatment--just as conventional HMOs are savagely criticized for doing? Maybe. Minnesota executives are convinced that the only long-term way to keep costs down without limiting services is to educate patients to take responsibility for their own care by following healthy habits as well as choosing and cooperating with the right doctors. Choice Plus is designed above all to give patients the information they need to do that...