NCQA: Finds Variations In Benefits And Services
A nationwide survey of HMOs by the National Committee for Quality Assurance released today indicates that there is little uniformity in health care from plan to plan, with managed care plans offering disparate benefits and services. The AP/Nando Times reports that the level of care varied widely between the best plans and the worst: "81% of older women have had mammograms" within the past two years in the best performing plans, while in the worst plans only 62.6% received the breast cancer screening. The contrast is even more stark for childhood immunizations, with 83% and 46.6% of two-year-olds receiving all of the shots in the best and worst plans, respectively. Striking regional differences were found in the survey, with New England HMOs outperforming every region "on nearly every measure," and South Central and Mountain states clustered at the bottom. Other disparities in care between the best and worse plans -- defined as the top 10% and bottom 10% -- included:
- Heart disease patients who received beta-blockers (93.1%/55%)
- Pap smears for adult women (82.7%/59.8%)
- Eye exams to diabetics (56.9%/20.4%)
- Smokers advised to quit (75%/55.1%)
- Prenatal care (95%/63.7%) (Meckler, 7/23)
What Are Ya, Scared?
The NCQA study encompassed 292 plans with a total of 40 million enrollees, plus 155 plans whose data was used to compute national and regional averages but was not released on an individual basis. In what the study authors called a "disturbing development," fewer health plans were willing to release their performance data publicly this year. While the report mentions slight changes in quality measures, the managed care "industry's overall performance was essentially unchanged from 1996 to 1997" (NCQA release, 9/23).
I Can't Get No...
The NCQA report also included a section on patient satisfaction, which showed that approximately 80% of health plan enrollees "did not have trouble with delays in care ... or problems seeing a specialist." Additionally, 56% were "completely" or "very" satisfied with their HMO. Thirty-eight percent said "their plans' availability of information about services" was "excellent" or "good," and "42% said the number of doctors they had to choose from was good or excellent" (Meckler, AP/Ft. Lauderdale Sun-Sentinel, 9/23).
NPR's Joanne Silberner this morning reported that the study should be taken with a grain of salt, as "the survey may not mean much to most Americans," noting that most consumers don't even have the opportunity to even choose their own HMO. Furthermore, "only 9% of mid- to large-sized employers use the [NCQA] accreditation to decide which plans they'll offer." But Silberner reported that costs are not driving employers away from using NCQA-accredited plans -- "Accredited plans cost 4% less than non-accredited plans" ("Morning Edition, 9/23). The NCQA website (www.ncqa.org) provides a wide variety of information about health plans and the accreditation process.