MEDICARE HMOS: Does Limited Access Promotes Preventative Care?
"HMOs do a better job than ... traditional Medicare at combating disease when care counts the most: before problems get severe," asserts a Sacramento Bee editorial. The Bee support its claims with findings from the Dartmouth Health Atlas, an annual survey of physician practice patterns in America. The "most striking" feature of this year's survey was the difference in levels of preventative care received under traditional Medicare vs. HMOs, despite HMO enrollees' lower out-of-pocket costs. "For less money, it turns out that seniors in HMOs are getting far more of the kind of care that flags health problems before they can ruin their remaining years," the Bee notes. The atlas reports that only 28 percent of women between the ages of 65 and 69 receive regular mammograms, while Kaiser Permanente boasts an 80% mammogram rate for the same group and PacifiCare a 70% rate. Despite its widely publicized disadvantages, the HMOs' inclusion of a gatekeeper may be the reason behind superior prevention efforts. "With seniors floating from doctor to doctor, and medical charts dispersed throughout various offices, it is difficult for even vigilant physicians to know what care patients are actually receiving," the Bee notes. HMOs, on the other hand, "can monitor that care and flag when women are missing their mammograms." The editorial concludes that, despite managed care's imperfections, it "isn't the problem. Making it better is the solution" (5/4).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.