I have been a disciple for prepaid medical plans, now called managed care or health maintenance organizations (HMOs), ever since the late great industrialist, Henry J. Kaiser, personally came to the Honolulu Star-Bulletin offices in 1958 to preach the gospel. The need for a
patients’ bill of rightsIt was simple: By agreeing to provide most health services for a flat fee, his plan would put the emphasis on keeping a patient well, reduce costly overtreatment and make medical care more affordable.
Kaiser plans invite members to free periodic checkups, shots, etc., all in the interest of wellness. Under traditional medicine doctors and hospitals collected money only when patients needed treatment. No sickness -- no pay.
"Find a need and fill it," was a Kaiser guiding principle, demonstrated to him in the health field when his mother died in his arms because of inadequate medical treatment when he was 14.
Kaiser went on to build the Hoover Dam, mass produce World War II cargo ships, manufacture steel and aluminum, and then "retire" in Hawaii to start Hawaii Kai, open a cement plant, build the Hawaiian Village Hotel and bring in from Oakland, Calif., his nonprofit Kaiser-Permanente health plan.
"Socialized medicine" was the label pinned on this radically different plan. The first doctors who signed on with Kaiser here were shunned by many of their fellows.
The managed care concept now has grown so strong that only 15 percent of American workers remain in traditional fee-for-service plans. Twice that many are in health maintenance organizations (HMOs) close to the original Kaiser concept. Twenty percent are in "point-of-service" HMOs that allow treatment outside the group for a higher fee. Thirty-five percent are in fast-growing "preferred provider" groups of doctors and hospitals that allow still wider choice.
Sadly, growth has corrupted many for-profit HMOs.
A 1997 poll by Harvard and a Kaiser Family Foundation totally separate from the health plan showed that 61 percent of Americans think managed care has reduced their time with their doctors, 59 percent find it harder to see medical specialists, 55 percent see little difference in costs, 51 percent think the quality of care for the sick has decreased and only 46 percent think it is easier to get preventive services.
Even though other reports still show wide managed-care support, this is a terrible indictment. Fortunately, it doesn't apply here, says Sen. Wayne Metcalf, co-chairman of the state Senate Consumer Protection Committee. The Hawaii Kaiser plans are rated among the best HMOs in America with high patient satisfaction scores. Metcalf has had few complaints.
Nevertheless, he wants Hawaii to join the federal government and some 40 states that have have enacted patients' rights bills. The federal health-care bill of rights covers only federal employees, the military services, veterans and American Indians.
The new laws include more information disclosure to patients, direct access to specialists for patients with serious conditions, thus by-passing the HMO gatekeeper's allocation of services, wider coverage of emergency room visits and a right to appeal denial of coverage to an outside panel.
The Hawaii senator wants to assure that new HMOs entering Hawaii also will be held to these standards.
THE goal is to mediate self-interest clashes that involve cost control, for which the need is widely accepted, the conflicting desire of many Americans for unlimited benefits, and excessive profit-squeezing efforts by some HMOs. Among the walking wounded are specialists whose numbers are out of proportion to the numbers of generalists and who are fighting reduced use of their services.
We, the public, need more independent measures of the quality of health-care delivery, more comparisons of cost-effectiveness and fuller information about our options.
By no means should we throw the baby out with the bath water. The keep-us-well emphasis of HMOs has a far greater identity with customer pocketbooks and health than pure fee-for-service plans.