Head of HMO Trade Group Fires Back

I was deeply troubled by your story on one person’s experience with an HMO, (“HMO Horror Story,” Jan. 2).

The implication that health maintenance organizations are not providing a high level of quality medical care to their 10.1 million California members is outrageous. At 41.3% of the insured population, California has the largest percentage of HMO enrollees of any state in the country. That percentage has steadily grown because people have chosen the quality, convenience and low out-of-pocket costs offered by HMOs based on their own and neighbors’ experiences.

Nationally, surveys of both consumer satisfaction and health care quality consistently score HMOs as equal or superior to other types of health plans. More recently, for example, a December, 1992, independent survey by the National Research Corp. found greater satisfaction among HMO members than enrollees of preferred provider organizations or conventional health insurance plans.

I was frustrated by the lack of medical information in the story, which would have provided some clues as to what had actually happened. Why is there no comment from the unidentified HMO? Or how about assessments from independent medical experts? Unfortunately, without these details, millions of readers have been left with vague, unsupported concerns about their health coverage.

Yes, people should carefully investigate an HMO or any other type of health plan before signing up. I look forward to constructive Times articles in the future on such topics as how best to make that important choice.

JAMES F. DOHERTY

Washington, D.C.

The writer is president and chief executive of the Group Health Assn. of America, a national trade association of HMOs.