NAME a topic," I said to my wife as I held up Kaiser Permanente's new Healthwise Handbook, a guide to self-care at home. "Sneezing," she said, because I sneeze a lot. It should have been in the index between "snakebite" and "snoring" but wasn't. Kaiser handbook
shows HMO differencePlenty else is there, though -- around 2,000 listings in all. Most of them direct users to a section that tells what the trouble might be, describes possible home treatment (which is sufficient 80 percent of the time) and tells what to do if home treatment won't suffice.
The basic book is used by a number of health plans. Former Surgeon General C. Everett Koop has authored a similar one. Like no other, however, the Kaiser Hawaii version has a chapter on such Hawaii concerns as centipede and Portuguese Man-of-War stings, sea urchin punctures, volcanic fog (vog) and hurricane readiness.
A national food guide pyramid on what foods to eat sparingly and which to consume generously is adapted to include chow fun, malassadas, manapua, poi, saimin and sushi (all in the most preferred category), plus seaweed, lychee, mango, papaya and more in the second best tier, then a third less-preferred tier including spam, opihi, octopus and tofu, and a "use sparingly" tier including coconut, lard, sodas and sweet desserts.
In pre-tests on Windward Oahu, more than 70 percent of Kaiser members used the handbook and said it saved office visits. One declared it saved his life. Now more than 100,000 Hawaii member families are getting copies.
The book has two thrusts: first, to promote and improve self-care home treatment when it will suffice and, second, to send patients with more serious problems in appropriate directions, possibly including a 911 call.
A Kaiser service that predates the handbook and still is useful is the opportunity for members to phone Kaiser and ask to talk to an Advice Nurse.
My wife once scalded herself on a flight into Baltimore. A call from Baltimore to a Kaiser nurse in Honolulu told us what to do and suggested medications to buy at a drug store. We saved both the humbug time and cost of looking for a doctor or hospital in Baltimore.
All by itself Kaiser's issuance of the handbook makes clearer the difference between traditional fee-for-service (FFS) medicine and HMO or health maintenance organization medicine such as Kaiser practices.
FFS providers are paid only when customers request their services. Home self-care thus deprives them of income.
With HMOs it's just the opposite. Customers pay flat fees, called capitation, whether they need help or not. HMOs profit most by keeping customers well.
The gray area between FSS and HMOs comes with serious illnesses. There's economic incentive for FSS providers to overtreat, for HMO providers to undertreat. Some specialists claim HMOs don't use them enough. Or are HMOs just cutting out overtreatments? Who can tell?
I have been a confirmed HMO advocate since Henry Kaiser braved withering opposition to expand his West Coast HMO to Hawaii in 1958. "Socialism," many said.
THE nationwide 1990s attack on health costs that were rising far faster than inflation turned government, employers and unions increasingly to HMOs.
Unfortunately, that rush brought in some fast-buck operators guilty of sacrificing quality care. These HMOs need tougher oversight and maybe some new rules. They are part of the growing pains of the HMO movement but not a reason to throw out its sound underlying principles.
Good news for customers of Hawaii's biggest HMO, Kaiser Permanente, is that U.S. News & World Report magazine has just rated it the sixth best HMO in America. Data was used from the National Committee on Quality Assurance, much of it based on treatment outcomes, to judge 223 HMOs in 46 states. In all, 10 Kaiser affiliates were in the top 37 judged four-star.
The old Henry Kaiser idealism remains. The new handbook is further evidence of it.