MANAGED CARE: Financial Woes Could Mean Trouble for Patients

      In a special report series, Sunday's Los Angeles Times took a look at how financial shakeups at managed care firms, such as the recent MedPartners Provider Network debacle, affect patient care.

• "An Rx for Disaster": Asking how managed care plans find their way to financial insolvency, the Times reports that the free market system may not be working and that stricter government regulation may be necessary. With plans failing, "continued weak regulation of the industry could spell trouble for millions of Americans ... but neither federal nor state officials have comprehensive plans to deal with the industry's problems" (Bernstein/Rubin/Rosenblatt, 3/28).
• "Health Care Industry's Fiscal Crisis Creates Turmoil for Insured Patients": The health industry's financial crisis will likely lead to the "worrisome" trend of disrupted continuity of care, the Times reports. It "appears certain ... that turbulence lies ahead for patients, doctors and others whose lives are touched by the health care industry" as consumers are likely to experience delays in receiving treatment and be forced to switch doctors. Some research shows that continuity of care is not only good for the doctor-patient relationship but makes for better care, such as lower hospitalization rates and dosage compliance (Silverstein/Maharaj, 3/28).
• "Financial Woes Threaten in Regions Where Managed Care Dominates": Setting the background in the discussion, the Times reports that financial woes of HMOs "loom biggest in regions where managed care has made the biggest inroads, where a dwindling group of players dominates the marketing of health care." California is a "bastion of managed care," with 38% of Los Angeles County and 42% of Orange County enrolled in HMOs (Rosenblatt, 3/28).
• "When Your Medical Group Won't Provide What You Need": The Times offers tips to consumers who have problems receiving care. Consumers should first talk things over with their doctor and then seek a second opinion or try to resolve the problem with the medical group's customer service representative. If that doesn't work, consumers should go to their HMO or insurance company because the medical group is usually a subcontractor to the HMO or insurer. Consumers should contact the state Department of Corporations, particularly if they have an urgent problem or suspect care is being delayed because of the HMOs financial situation. "If all else fails," enlist the help of a consumer advocacy group, such as the Cancer Legal Resource Center (213-736-1455), the Western Law Center for Disability Rights (213-736-1031) or the Health Consumer Center of Los Angeles (800-896-3203) (3/28).