CONSUMER COMPLAINTS: State Officials See Big Increase
Consumers' complaints about health insurers and HMOs are "surging," according to state health insurance commissioners. However, the New York Times reports that the commissioners "say they doubt that the rise implies a deterioration in care," but rather the numbers reflect "greater public readiness to fight HMOs" and the fact that many states are encouraging consumers to file complaints. "We are beating the bushes," said New York Insurance Commissioner Neil Levin. "The public is learning to use the system," said Kip May, deputy director of the Ohio insurance department. According to interviews with 12 state insurance departments, health care complaints have grown "50% over the last one to three years, far faster than" HMO enrollment has grown. The National Association of Insurance Commissioners projects that 35,000 consumer complaints regarding HMOs and other health plans will be filed by the end of this year.
Managed care officials are quick to point to surveys which regularly show an 80% to 90% approval rating among managed care consumers. Bill Pierce, spokesperson for the Blue Cross and Blue Shield Association, said politicians have "fanned public fears" of HMOs. "It's in Hollywood," he said. "On the campaign trail." Chip Kahn, COO of the Health Insurance Association of America, noted that 35,000 complaints per year from 77 million affected enrollees are not bad numbers. "You should have zero tolerance for problems," he said, but "[i]nevitably, there are going to be some."
But it is not just the amount of complaints that is changing, it is also the type, say state officials. "Before it was about who pays. Now it's about whether you get the service at all," said health care analyst Patricia Butler. Karen Pollitz of Georgetown University's Institute for Health Care Research and Policy said the 80% of consumers who are happy with their health plans are most likely healthy and don't utilize services much. This group can eclipse the 10% or 15% who aren't pleased, she said. "If you're just carrying their card in your pocket, what are you going to complain about?" she asked.
In New York, complaints about health plan actions have increased "sixfold" since 1996. Levin attributed "much of the increase to the travails of one leading HMO, Oxford Health Plans, and to fee disputes with physicians." In Texas, where a "new law allowing complaints by physicians" was recently passed, complaints have been steadily climbing, from 131 in 1993 to 846 in 1996 to nearly 5,000 in the fiscal year ending August. But one exception to the trend is Minnesota, where HMOs have been tightly regulated for years. According to Kent Peterson, the Minnesota Department of Health's director of managed care services, "complaints have dropped over the last few years to 600 or 700, from an average of 1,300 a year in the late 1980s" (Kilborn, 10/11).
Call For Reform
In North Carolina, many consumers believe HMOs need more regulatory oversight. According to a "Your Voice, Your Vote" poll, 80% of North Carolinians "say HMOs should be held legally responsible for complications that occur when medical treatments are denied." Ninety-four percent "said insurance companies shouldn't have the right to overrule doctors' treatment plans." In addition, 62% said they were "very" or "somewhat" worried about their ability to afford care, and 68% said they are worried about quality. The Raleigh News & Observer reports that the poll comes at a time when HMOs "are trying to become more consumer friendly." Just last week, Blue Cross and Blue Shield of North Carolina "endorsed" President Clinton's "patients' bill of rights" (Clabby, 10/11).
Glendening Jumps On The Bandwagon
In Maryland, Gov. Parris Glendening (D) today is expected to come out in support of consumers' "right to sue" their HMOs. The Baltimore Sun reports that this sentiment is new for Glendening, "who laid out in July a patients' bill of rights that did not include the provision." Glendening spokesperson Peter Hamm "declined to comment on today's expected announcement." But sources said the governor "will also throw his support behind a proposal to require that a managed care organization's medical director be subject to the same disciplinary power as practicing physicians." State Senate President Thomas Miller (D) said Glendening's support of the right-to-sue issue "would spark an emphatic debate in the State House." He said, "It's an issue that's volatile and it has merits on both sides. I would hope we could fashion some kind of compromise." The governor's challenger in the upcoming election, Ellen Sauerbrey (R), "opposes changing the law to allow lawsuits against managed care organizations," but supports the medical director provision. She said the right-to-sue measure would "drive up the cost of health care tremendously," creating "a lot of wealthy attorneys and a lot of uninsured people" (Waldron/Zorzi/Dresser, 10/13).
Lies And Videotape?
Consumer groups' latest evidence "that patients need more protections," may be an Aetna "training video that implies that the company gives more attention to cases" of patients that have the right to sue than those who don't. As part of a court case against Aetna, the tape was recently made public. Consumers for Quality Care is sending transcripts of the tape to members of Congress. "We released this to fuel the HMO debate and to tell Congress it's absolutely outrageous that they would adjourn without dealing with this," said CQC's Jamie Court (Meckler, AP/Ft. Worth Star-Telegram, 10/13).