HMOs Gaining Despite Love-Hate Relationship : Health: O.C. residents joining the systems say they cut costs. But some complain of long waits and bureaucracy.

About a year ago, Linda Voll of Lake Forest reluctantly parted with her family physician of 12 years to join Kaiser Permanente. The reason was purely economic.

The mother of two teen-agers said her family has no exceptional medical problems--just an occasional flu, sports injury or migraine headache--but that their previous medical insurance cost $3,000 or more a year in deductibles, co-payments and disallowed doctors’ fees.

“I don’t care how much I loved him or how good he was,” Voll said of her former doctor. “To owe $3,000 to $4,000 a year is ridiculous.”

Under Kaiser, the Volls now pay $5 each time they visit a doctor, whatever the problem. Medications cost only $5 per prescription. And the family is no longer in debt for medical expenses at the end of the year.

Increasingly, Orange County families like the Volls and elderly people on fixed incomes are giving up their traditional medical plans and flocking to health maintenance organizations such as Kaiser and more than 20 other HMOs to escape back-breaking medical costs.

But if President Clinton, who experts predict will choose HMOs as the model for national health care reform, opened his ears in Orange County, he’d hear about the love-hate relationship consumers have with their HMOs.

While supporters say the system promotes preventive medicine and sharply reduces the cost of treatment and medication, critics tell other stories about long waits for doctors’ appointments, not being able to see the same doctor regularly, long drives to HMO-designated facilities, and fighting the bureaucracy for approval to see a specialist.

“For an everyday-type thing, I think this is good,” Alan Lenning of Anaheim said of HMOs. “But if it is something life-threatening, you have to jump on some toes to get things done.”

Yet other patients regard the downside of HMOs as an acceptable trade-off.

“I would like to have a doctor who knows me by my first name, but you can’t have everything,” said Margie Soto of Mission Viejo, who, like most consumers joining HMOs, was attracted mainly by the savings.

One thing is not in dispute: HMOs have caught on here and elsewhere.

More than 887,000 Orange County residents belong to the 17 largest HMOs available locally, according to a survey published in February by the Orange County Business Journal, up 32% from a similar survey the previous year.

HMOs are more prevalent in Southern California than in most of the nation. About 85% of Orange County employers in 1992 offered their employees HMOs, compared to 61% of employers nationally, according to A. Foster Higgins & Co., an employee benefits consultant.

The firm’s survey of 145 employers in Southern California found that 42% of their employees belonged to HMOs, compared to 26% nationally.

“Managed care has worked very well for Orange County,” said Michael Fox, Foster Higgins’ Orange County manager. “Whereas the total increase in health care costs for the country was 10.1% last year, in Orange County that increase was only 6.2%.”

Foster Higgins reports that the cost gap between traditional indemnity plans and managed care plans is widening: Traditional plans cost an average of $4,276 per employee in 1992, more than 20% higher than the average HMO cost of $3,124.

What’s the difference between traditional indemnity plans and HMOs?

With traditional insurance, consumers have the freedom to choose any doctor but are required to pay the doctors’ fees and apply to the insurance companies for reimbursement. Insurance typically pays only 80% of doctors’ fees after a deductible is met and often nothing for prescriptions.

Under HMOs, doctors who become HMO employees or contract privately to treat system members are paid a flat monthly rate for each patient assigned to them, and thus are strongly motivated to contain costs. Also, HMOs require patients to see primary care physicians who, as “gatekeepers,” regulate access to more expensive specialists.

The Voll family illustrates how the difference between traditional health care plans and HMOs translates into cost savings for consumers.

Voll and her husband, Dale, are self-employed owners of an auto body repair shop and pay $390 a month for their Kaiser family medical plan, compared to the $585 they paid for a Blue Cross indemnity plan.

And their out-of-pocket savings are also significant. One afternoon, Voll drove the short distance from her Lake Forest home to a Kaiser clinic in Mission Viejo to pick up a new drug to ease her migraine headaches.

Under her old Blue Cross plan, which did not include prescriptions, Voll could buy the medicine at any drugstore for $40 per dose. But at the Kaiser pharmacy she bought two doses for $5.

Many elderly people on fixed incomes are discovering the financial benefits of HMO health care.

Silvia, 71, a Laguna Hills Leisure World resident who wanted to be identified only by her first name, said she decided to join an HMO plan for Medicare recipients called Secure Horizons after paying thousands of dollars in medical bills that traditional Medicare did not cover for her husband, before he died of cancer.

“I don’t have any chronic illness, but you have to think of the future,” Silvia said.

Many lower-income people also are grateful for the affordable care that HMOs offer.

Ruben Manriquez, a maintenance technician for the Irvine Unified School District, said he and his wife are happy to have the Cigna Healthplans. Manriquez said if one of his two children is sick in the morning, he can usually get a doctor’s appointment the same day. It doesn’t matter to him, he said, if they see a different doctor each time.

When Manriquez learned that Cigna was probably cheaper for his employer than traditional medical insurance, he was astonished. “For the care we receive, I thought it was more money,” he said.

Some HMO enthusiasts say they initially feared getting inferior treatment but now believe they receive exemplary care. Some praised the skill of nurse practitioners, whom HMOs employ to perform at a lower cost some of the tasks doctors once did.

Debbie Gray of Orange said a Cigna nurse practitioner taught her child safety and breast feeding classes before the first of her three children was born 10 years ago. “I followed her from Santa Ana to Westminster to here,” the Cigna office in Orange, Gray said.

Not everybody praises HMOs.

Leona Kindt, who belongs to Cigna through her job as a clerk in the Orange County Juvenile Probation Department, said that when she joined Cigna she struggled to persuade her primary doctors that she needed the expertise of specialists.

“I had a bladder problem for six months straight before I was referred to a urologist,” Kindt said. By the time an emergency room doctor wrote Cigna a note recommending that she see a specialist, Kindt said she was so tired of feeling ill that she had gone back to her former urologist “and he took care of it.” She had to pay out of pocket for the private physician.

Patricia Samhammer of Laguna Beach, who recently accompanied her sister-in-law to the Kaiser Permanente clinic in Irvine, said she and her husband would never join the HMO because of the delay her mother had experienced a year ago in obtaining treatment for recurring cancer.

She blamed “the structure” of the medical delivery system for making her mother wait so long before an appointment that the woman wound up having to visit the emergency room.

Also, HMO members often gripe that they are seldom able to see their preferred doctor if they need immediate attention. “Sometimes you wait a month to see your doctor,” said Soto of Mission Viejo, who uses the Kaiser clinic there. “It lacks the personal touch I was used to with a private doctor.”

Administrators of HMOs say they are striving to overcome their shortcomings. For example, Kaiser officials said the company recently installed a central computerized telephone system that has shortened the time for members to make doctors’ appointments.

In response to surveys showing that most satisfied members had a personal relationship with a family doctor, FHP, a Fountain-Valley based HMO, has changed its system in Orange County to make each primary physician responsible for a specific group of patients.

And at Cigna, the goal “is to make people feel they have a family doctor,” said Bert Wagener, president of Cigna Healthplans of California. He said the company recently began allowing more patients to see doctors the same day they call for appointments.

Wagener believes customer satisfaction is increasingly important in health care competition. “There will be more and more consumer involvement in the selection” of health plans, he predicted.

Peggy Weismair, a nurse who is a medical case manager at the senior center in Laguna Hills near Leisure World, said she has seen improvement in Medicare HMOs, such as FHP and Secure Horizons.

“Three or four years ago all you heard were negatives” from members of senior plans, Weismair said. But now, she said, she hears far fewer complaints about long waits for doctors’ appointments or the frustration of trying to communicate with HMO doctors.

Those who counsel seniors say that local HMOs are taking great pains to educate prospective members since federal health officials discovered in 1991 that FHP sales representatives were sometimes neglecting to inform seniors that after joining they would no longer be able to visit their longtime doctors.

However, now there are still complaints that some HMOs for Medi-Cal recipients mislead prospective customers in high-pressure, door-to-door sales campaigns.

“The people I talk to are not very happy with the plans. There is a lot of confusion,” said Jennifer Young, a nurse who works in the St. Jude HealthMobile, a van that brings health care to the working poor in north Orange County.