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The HMO backlash


Survey finds skepticism about managed-care motives

November 5, 1997
Web posted at: 5:04 p.m. EST (2204 GMT)

From Correspondent Jeff Levine

(CNN) -- In general, people are pleased with their personal medical coverage, but those who belong to a health maintenance organization tend to believe their HMO cares more about saving money than it does about them, a survey found.

Mark and Lisa Burns are among those who feel that way. The Burns, both nurses, were in for a shock after taking their son Eric to an emergency room in July. They feared the boy had appendicitis, but when his illness turned out to be constipation, the family's HMO wouldn't pick up the $750 bill.

The HMO said it wasn't a real emergency, a decision that angered Mark Burns as he tried to convince the managed care provider to help cover the cost.
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Six weeks later, the Burns finally got their claims paid. But such complaints are frequent, says Drew Altman of the Kaiser Family Foundation, which financed the study. "The managed care industry has a real image problem," he told CNN.
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Overall, most Americans surveyed felt their personal health plans deserve a grade of "B" or better. But the study also reveals concerns that add up to an HMO backlash:

  • 59 percent complained managed care makes it tougher to see a specialist.

  • 51 percent worry that the quality of treatment has gotten worse.

  • 55 percent say HMOs care more about money than about providing the best treatment.

Altman says the foundation was surprised to see such "strong" results.

For its part, the managed care industry says it's responding to consumer anxiety. "The challenge for us is to demonstrate that we are taking information presented in the polls seriously and that we are making changes when needed," says Susan Pisano, a spokeswoman for the American Association of Health Plans.

But in case the industry doesn't get the message, the forces of change are already at work. Both the White House and Congress are looking at a variety of remedies to deal with the HMO backlash.


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