|
Are HMOs the wrong prescription for patients?
April 3, 1997
Web posted at: 11:55 p.m. EST (0455 GMT)From Correspondent Al Hinman
WASHINGTON (CNN) -- Steven Herod, a patient, tells what many in the health-care industry consider an HMO horror story.
He says his Health Maintenance Organization informed him that his potentially fatal heart condition was too complicated -- and costly -- to treat.
"They basically told me they didn't want to have anything to do with me," Herod said. He eventually bypassed the HMO system to find doctors who would help him.
The managed-care industry contends such cases are rare. HMOs and other managed-care plans serve 140 million Americans. But unless they make major changes, two veteran health-care researchers predict they won't be around much longer.
In an opinion piece in the New England Journal of Medicine, the Columbia University authors write: "Managed care of and by itself will be unable to answer the needs of the American people for universal coverage, sustainable financing ... and better care."
Although the head of an association representing managed-care plans acknowledges problems, an industry spokesperson said the report is overly pessimistic about the future of the HMO.
"I think it's a very narrow view, and I think it's wrong," Karen Ignagni of the American Association of Health Plans said.
Dr. Jerome Kassirer, editor-in-chief of the New England Journal of Medicine, said managed care must change to survive.
"If managed care in general can be made to behave, that is, not to restrict care, to allow patients access to specialists, to help with the payment of the care of the poor and things like that, then I think managed care is likely to survive," Kassirer said.
Can the managed-care do what it has to survive?
The Columbia University authors don't think so.
"Unfortunately, the solution to these problems lies beyond the inherent capabilities of the managed-care system," their report says.
Ignagni disagrees.
"We have in place the mechanism that should assure individuals -- as it assures our members -- that physicians are accountable, that costs are affordable, that we are providing care where heretofore care was not available," she said.
Patients such as Herod remain unconvinced.
Related sites:
Note: Pages will open in a new browser window
- What is an HMO?
from Columbia University's "Healthwise - Go Ask Alice" feature
External sites are not endorsed by CNN Interactive.
Tell us what you think!
You said it...
© 1997 Cable News Network, Inc.
All Rights Reserved.