Patient Care in HMOs

* The untimely death of Joyce Ching is nothing less than tragic (“Cutting Medical Costs--or Corners?” May 5). No one likes to hear about stories like Mrs. Ching’s. They make us realize how vulnerable we all are--that the same could happen to any of us anywhere. We are not immune.

At the same time, tragedies like this do not happen exclusively in HMOs. It is not fair to imply that HMOs are single-handedly responsible for all the calamities in our health care system, particularly since they are employer to thousands of hard-working Californians who are truly dedicated health care providers and supporters.

The vast majority of HMO beneficiaries are significantly more satisfied with their health plan than those enrolled in traditional indemnity plans. Managed care provides an array of preventive health care services to keep people healthy, and assure a quick recovery when they do become ill--at an affordable price.

BETTY CARSON RN

Californians for Quality Patient Care

San Bernardino

* As a retired surgeon, I read the article on the death of Joyce Ching with much interest. I worked for several years for an HMO (Kaiser) and practiced many years privately. I also worked as a medical missionary in India for five years at poverty-level wages.

The capitated system, which allows a fixed amount per “head” (patient), has only one purpose--to be competitive in what has now become the health “Industry.” But you don’t get a Cadillac for a Volkswagen price.

The “gatekeeper” of this plan is just that, he stands guard to restrict assess to costly tests and referrals to more highly trained and paid specialists. The only people who benefit without risk are the administrators--at great profit. They, of course, can’t be responsible if one of their physicians, squeezed by the system, tries to be a “good” HMO physician and cuts corners.

What makes the system work is what every physician knows: Most people who seek medical care are not seriously ill. I feel sorry for the really sick patient or the one with an occult, but diagnosable, disease who is a member of a capitated system. I also feel sorry for the little gatekeeper at the big gate. He is flanked by two monolithic gateposts. One one side is the HMO (“Hold the Money Organization”). And on the other is the Trial Lawyers Assn.

JOHN M. SOUTHWELL MD

San Clemente

* At last you have exposed the insurance companies, showing their sinister greed. They keep raising the premium they charge the public, reducing their payments to doctors, raising the salaries of their presidents (some are in the millions), and accumulating cash to buy other insurance companies and eliminate competition.

The company you mentioned is generous. It pays $27.94 per person per month for all his/her medical needs. If we don’t stop these insurance companies, they will soon contract with hospitals in Mexico or the Caribbean. A contracted moving company will take care of the patient shipping and handling.

ABRAHAM KATTAN

Beverly Hills