PATIENTS’ RIGHTS: HMOs Have PR Problem

      A new CNN/Time survey finds that Americans generally want some type of reform in how HMOs and other health plans operate. Only 36% of respondents said there is "a crisis in the way HMOs and other managed care providers treat their patients," but 51% agreed that there is "a problem, not a crisis." When asked what degree of action is needed to address HMO problems, only 38% said a "great deal of reform" is necessary, compared to 46% who said "only some reform" and 8% who favored "no reform at all." On health care in general, 52% said a "great deal of reform" is necessary, compared to 40% in favor of "only some reform." Sixty-nine percent said the government "should guarantee health care for all Americans."
      While 38% said they "worry" that their health plan "might deny ... certain kinds of medical treatment in order to cut costs," few respondents actually experienced problems with their HMOs over treatment coverage. Only 10% of insured respondents said they had been denied treatment they thought was necessary; only 12% said their health plan had overruled their doctor, and only 11% said they made a non-authorized trip to the emergency room which their health plan later failed to cover.

The Good Old Days
      On larger-scale questions, managed care was the big loser. Only 17% of respondents said HMOs provide better care than other types of coverage, compared to 68% who said fee-for-service plans provide the best care. Thirty-seven percent said HMOs have "made worse" the quality of health care in America, compared to 19% who said HMOs had improved quality.

Reform! Reform!
      The CNN/Time survey also asked respondents about various HMO reforms now being considered. Wide majorities supported every reform mentioned: 79% said patients should be able to choose their own doctor rather than having one assigned by the HMO; 72% said health plans should cover emergency health services even if prior authorization is not obtained; 70% said health plans should cover specialist care recommended by a primary care doctor, even if the treatment was not approved by the plan; 70% said patients should be able to appeal treatment decisions to "a neutral third party" and 63% favored giving patients the right to sue their health plans "for decisions made regarding the patients' medical care." The CNN/Time survey of 1,024 adults was conducted June 30 to July 1 (7/2).

One Pollster's View
      Democratic pollster Mark Mellman, on what is driving public "anxiety" about health care: "In the public mind, they see somebody 2,500 miles away, in some insurance company or health care plan sitting behind a computer terminal telling their doctor what procedures that doctor can use, what medicines that doctor can prescribe, what treatments and tests that doctor can use. And the public says enough of that" ("Inside Politics," CNN, 7/6). Don't miss this week's Time magazine cover story on managed care -- www.time.com.