Cal-OPTIMA Audit Misleading

Re “A Very Good Report Card,” Oct. 15 editorial:

The Times lauds Cal-OPTIMA for its high score on a state audit, implying that access and quality of care were good. Unfortunately, the audit merely measures compliance to minor requirements such as record keeping and calibration of medical equipment. The critical deficiencies resulting from the flawed structure of this program are not subject to review by such audits.

Cal-OPTIMA accepted medical funds which, to begin with, were inadequate to cover the costs of care, and turned them over to an assortment of managed care plans.

The administrative costs of Cal-OPTIMA, of the numerous contracted plans, of other intermediaries and the increased administrative demands on the practices have increased expenses from 3% to 30%, creating a structure that is far more expensive and intrusive than any governmental bureaucracy has ever been. Such waste of Medicaid dollars compounds the problems of underfunding.

The few specialists that were willing to see patients under the Medi-Cal program have been dispersed among these various plans, greatly impairing access to essential specialized care. Frequently, urgent specialized care can be obtained only by sending these patients to emergency rooms. This expensive care, of course, wastes more of these very limited funds.

The monthly changes of eligibility requirements cause patients to move in and out of the various Cal-OPTIMA plans, usually resulting in frequent changes in primary providers. Such disruptions make it very difficult to provide continuity of care, and to follow through on plans that often require delays due to authorization procedures. Many of these patients have serious problems that deteriorate further with such disruptive care. Audits do not show the care that is provided gratis while the patient is locked up in this bureaucratic chess game.

All of this is unnecessary. There is almost unanimous agreement that we must provide universal access and coverage. At 14% of our GDP, we have more than enough funds to provide quality care for everyone. It is time for us to do what all other industrialized nations have done, and that is to adopt a system of universal health care.

DON R. McCANNE, M.D.

San Clemente