CALIFORNIA HMOS: 42% OF ENROLLEES REPORT PROBLEMS
A new survey commissioned by California Gov. Pete Wilson'sThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
(R) task force on managed care reform found that "42% of those
with medical insurance had a problem with their health plans in
the last year," the Los Angeles Times reports. Extrapolating
from the survey of 1,200 Californians, researchers at UC Berkeley
and the Field Research Corp. projected that 6.72 million
Californians had "some type of problem with their health plan."
Approximately 1.6 million people experienced recent problems with
"denial or delays in getting medical treatment, inappropriate
care or difficulty getting referrals to physician specialists."
Of the projected number of Californians reporting some difficulty
with their health plans, 21% (1.4 million) said the problem "led
to the worsening of their medical condition."
DIFFERENCES BETWEEN PLANS
Despite enrollees' reported difficulties, 76% of
Californians with insurance said they were "satisfied" or "very
satisfied" with their health plans. Only 10% reported that they
were "dissatisfied" or "very dissatisfied." The study looked at
all types of insurance, including PPOs. However, because only 3%
of Californians with private insurance are covered by traditional
fee-for-service plans, the study focused primarily on managed
care plans. The survey also found significant differences in
satisfaction levels among various managed care plans. The Los
Angeles Times reports that patients in group/staff model HMOs --
Kaiser Foundation Health Plan "accounts for nearly all such
members" -- were the most satisfied with their health plan, while
patients in IPA model HMOs were the least satisfied. Forty-four
percent of enrollees in group/staff models reported that they
were "very satisfied" with their plan, while only 29% of patients
in IPA models said they were "very satisfied."
Members of the California managed care task force disagreed
about the importance of the survey results. Jeanne Finberg, a
senior attorney for the Consumers Union, said, "I think these
numbers are going to shock a lot of people." State Assemblyman
Martin Gallegos (D), the author of "tough HMO reform bills" in
the state Legislature, said, "The task force members ... are
about to bring forth recommendations that are very weak, watered
down and industry-friendly despite the fact that they now have
these figures staring them in the face." However, Alain
Enthoven, head of the task force and an architect of managed
health care, downplayed the significance of the survey, saying
the findings were "likely to be exaggerated by critics of HMOs."
He said, "All health insurance has features that cause
frustration. ... Now that managed care is the dominant paradigm,
it gets all the heat and frustration about health insurance in
general." Enthoven said HMOs are often blamed for problems over
which they have no control, noting that "when consumers complain
that important benefits were not offered ... they often do not
realize that it is employers -- not health plans -- that decide
which benefits to offer."
According to the Los Angeles Times, the "managed care
industry will find little to like in the study." And an
"industry official" yesterday "cited the survey's findings that
76% of insured Californians said they are 'satisfied' or 'very
satisfied' with their health plans." California Association of
Health Plans CEO Myra Snyder said, "We'll analyze this survey and
pull out any lessons to be learned."
The survey was commissioned last summer by a task force
charged by Wilson with recommending reforms to the managed care
industry. However, the report was not released "to the 30-member
committee until the last few days," once the "panel's work was
near completion." Philip Romero, executive director of the task
force, "said the study's findings will be included in a separate
chapter of the panel's report to be released in January."
Although the survey results came too late for consideration by
the task force, the Los Angeles Times reports that "they offer
fodder for critics and proponents of managed care when the state
Legislature takes up HMO reform next year." Wilson vetoed
several dozen managed care reform bills last fall "saying that he
preferred to wait until the task force issued comprehensive
recommendations." According to health experts, the survey is
"likely to powerfully influence the debate in California and
nationally about how to regulate the managed care industry"