HMO Members Find Quality of Programs Much Superior to Traditional Health Care

Since PacifiCare was mentioned in your Viewpoints column, we felt it necessary to clarify some points.

The article stated that PacifiCare advertised a taxpayer-subsidized Medicare division program as the equivalent to a medical free lunch for consumers. What was not mentioned is the fact that Medicare risk contract programs, such as PacifiCare’s Secure Horizons, receive 5% to 7% less reimbursement than traditional Medicare, yet they provide patients $30 to $50 more in benefits per month than would normally be covered by traditional Medicare.

These programs are extremely popular in areas with a large populations of senior citizens. San Diego, for instance, has more than 7,000 Medicare consumers on waiting lists to enroll. Member satisfaction levels in these programs run as high as 97%.

The recent publicity surrounding Maxicare’s financial woes has focused public attention on the HMO industry and raised questions as to why a large program should be facing serious financial problems. Most health-care executives familiar with the Maxicare situation are fully aware that the company’s problems have been due primarily to an over-aggressive expansion program.

Providing cost-effective, quality health care can only occur if a plan has physicians committed to continually improving their management of patient care. The fee-for-service, production-oriented method of health-care delivery is becoming obsolete as medical costs continue their rapid climb and is being replaced by managed care.

Meanwhile, HMO programs around the country are experiencing record growth. Mature programs such as PacifiCare and Kaiser offer the best opportunity for society to manage health-care costs and also monitor the quality of care delivered. As a result, corporate leaders are discovering that HMOs are the best available solution to controlling their medical costs.

JAMES MOFFAT, M.D.

Cypress

The writer is vice president and medical director of the PacifiCare Health Systems health maintenance organization.