CALIFORNIA: MANAGED CARE PANEL RELEASES RECOMMENDATIONS
The California Managed Care Health Improvement Task ForceThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
Saturday released its recommendations for improving managed care
in the state, the San Diego Union Tribune reports (Ainsworth,
12/16). Stanford University professor Alain Enthoven, who
chaired the panel, said, "I'm very pleased with our progress.
The recommendations taken as a whole could make a significant
difference and should help to restore the public's trust in the
health care system" (release, 12/13). The panel recommended that
health plans give "more information to patients about financial
incentives that may discourage treatment and allow permanent
referrals to specialists." In addition, the group "urged the
overhaul of the way HMOs are regulated" and recommended the
creation of a new regulatory authority to oversee HMOs.
Currently, HMOs are regulated by the Department of Corporations,
but according to Alain Enthoven, a problem with the Department of
Corporations is that "neither the leader ... nor the personnel
know a lot about health care." The new authority would be
composed of health care experts. However, the panel was not able
to agree on whether the regulatory group should be led by a
single person or a five-member board of directors. That decision
will be left to the state Legislature.
MORE RECOMMENDATIONS
The Union Tribune reports that although the panel did not
reach agreement on some of the most contentious issues, "it made
dozens of recommendations on smaller but significant issues that
are likely to be translated into legislation" next year. Jeanne
Finberg, task force member and representative of the Consumers
Union, said, "They are quite modest, but they move in the right
direction." The recommendations could help revive Assemblywoman
Susan Davis' (D) bill to allow access to OB/GYNs without a
referral from a primary care physician. The bill was vetoed by
Gov. Pete Wilson (R), but the task force voted unanimously "in
favor of the recommendation" (12/16). The task force also agreed
to suggest the creation of standard coverage contracts to serve
as "meter sticks against which health plans would be required to
compare their products so that consumers could more easily see
differences among insurance products" (release, 12/13).
MISSED OPPORTUNITIES
However, some consumer advocates were disappointed because
they felt the panel "missed an opportunity to make significant
changes to health care because it was controlled by health
industry representatives." Assemblyman Martin Gallegos (D) said,
"I was sadly disappointed that a lot of the recommendations fall
short of reforming the HMO system." Gallegos criticized the
panel for "failing to recommend that HMOs that rely on
arbitration to handle patient disputes be required to use neutral
arbitrators." Consumer advocates were also disappointed because
the panel did not recommend that consumers be allowed to sue HMOs
"for injuries caused by denial of coverage." Gallegos said, "The
majority of the members turned their back on holding HMOs
accountable for their decisions." According to Enthoven, the
panel was concerned that increasing the number of lawsuits could
lead to "costly defensive medicine."
THE BIG PLAYERS
The task force recommended that "large public purchasers of
health care ... improve compensation for those plans that enroll
a disproportionate number of less-than-healthy patients." The
panel also recommended that patients be allowed to continue
seeing the same doctor, "if the patient or doctor has to leave
the plan involuntarily." The task force will draw up its
executive summary January 5, the Union Tribune reports. Click
here to view the task force's Web page (12/16).