Word: patients
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Dates: during 1990-1999
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...nearly anybody who has come into contact with the system can recite a litany of horror stories: nitpicking "utilization reviews" of doctors' bills by insurance-company bureaucrats; patients hustled out of a hospital within hours, even after surgery as traumatic as breast removal; gag orders forbidding doctors to tell a patient about an expensive treatment. A recent addition: a patient rushes to an emergency room with what feels like a heart attack but turns out to be only gas pains--and gets zapped with a huge bill because his HMO will reimburse only for a "real" emergency...
This may be an extreme position, but there is ample evidence that the bottom-line mentality is taking over. HMOs refer to the proportion of premiums they pay out for patient care as their "medical-loss ratio"--a chilling choice of words. The Association of American Medical Colleges reported last November that medical-loss ratios of for-profit HMOs paying a flat fee to doctors for treatment averaged only 70% of their premium revenue. The remaining 30% went for administrative expenses--and profit. Other surveys have yielded less alarming figures, and even among profit-making HMOs, there is a wide...
That is no comfort to doctors and patients. For-profit plans are reacting to the recent slippage in net by negotiating huge mergers. Some analysts predict that the 30-odd managed-care insurers that compete today in California will be concentrated into seven to 10 by 2005. Such giant combines might be able to hike premiums while squeezing spending on patient care even tighter in an effort to rebuild their margins--and continuing to let their chief executives pile up personal fortunes in salary and stock. One survey found that the salaries of HMO chiefs averaged 62% higher than those...
Meanwhile, managed-care companies are squeezing payments to doctors so tightly that in late December 485 Denver-area physicians scrapped their HMO provider, Antero Healthplans, rather than accept a 15% cut. Their 3,000 patients had to scramble over the holidays to find somebody to treat them. Most wound up back with their old doctors, but after enough anxiety to underscore a remark by Peter Van Etten, president of Stanford Health Services: "In this insanity of economics in health care, the patient always loses...
Cynics may contend that doctors mainly want to protect their incomes by preventing HMOs from lowering capitation (per patient) payments. In California, where HMOs are most dominant, the average earnings of a primary-care physician dropped from...