Quality of Care in HMOs

Re “Madison Ave. Meets Marcus Welby,” Commentary, Feb. 19:

On behalf of the California Assn. of Health Maintenance Organizations (CAHMO), I must respond to this rather misleading opinion piece. The notion that HMOs restrict services and choices, or raise profits by reducing quality of care, is simply not true.

CAHMO, which represents virtually all Knox-Keene licensed HMOs in the state, commissioned a review of the literature on the quality of care in HMOs as compared to the traditional, unmanaged fee-for-service system. The study (“Quality Of Care In HMOs: A Review of the Literature”) found that the numerous studies of HMO care over the years demonstrate that the quality of care in HMOs is equal to or better than that of the traditional fee-for-service system.

Unlike the traditional fee-for-service system, HMOs have no financial incentives to provide unneeded or questionable services that put patients at risk. Because HMOs receive the same prepaid fee no matter how much care members require, HMOs have a built-in incentive to control costs and improve the health of their members. Underutilization of health care services for patients can lead to serious illness, costly malpractice suits and loss of membership in HMOs; thus, HMOs have a strong incentive to provide the right balance of health care.

HMOs provide members with an array of preventive health care services to keep patients healthy and to help patients recover quickly when they do become ill. In the traditional fee-for-service setting, high physician fees, coinsurance and deductibles may discourage patients from seeking preventive care.

In addition, contrary to the charge that HMOs restrict services and choices, HMOs offer preventive care, educational programs, outreach and other benefits not offered by traditional insurance plans, HMO members have a choice among a large number of physicians from the plan’s and a member can change plan physicians at any time.

MYRA C. SNYDER

Executive Director

CAHMO, Sacramento