Au Contraire, One Can Ascertain HMO Quality

The letter by Daniel D. Crowley (“HMOs and Oversight of Medical Services,” Dec. 10) claims that the quality of medical care will, on the average, always be higher in HMOs than fee-for-service plans. He cites the numerous in-house and external reviews to substantiate his case.

What he doesn’t say is that these reviews were established because of consumer dissatisfaction with the quality of medical care in HMOs compared with fee-for-service. Measuring something does not improve its performance.

By the very structure of HMOs as profit-generating entities for a fixed fee per enrollee, the bias is against providing adequate medical care in the case of serious illness. Crowley claims that before the extensive reporting on HMOs, consumers had no way of determining the quality of medical care delivery. This is not true. Quality can be ascertained by referral, word of mouth and the ratings of medical providers that are published. The major advantage of fee-for-service is that if a consumer is dissatisfied, he or she can choose any other doctor or hospital.

In an HMO, this choice is limited to providers who are under the same constraints that the original unsatisfactory provider was. A knowledgeable consumer can always get better health care in a fee-for-service plan than an HMO.

DAVID HILTS

La Palma