A Healthy Step Backward

Blue Cross of California says it wants the 2.2 million members in its health maintenance organization to be content with the care they receive, and it plans to begin rewarding doctors on the basis of their patients’ satisfaction instead of for cutting costs. When it’s news that a health care provider rediscovers that its first responsibility is patients’ welfare, that shows just how far off course the practice of medicine has been dragged. Blue Cross’ decision, certainly prodded by the patients’ bill of rights now being considered in Congress, is likely to force other HMOs to shift their priorities toward greater patient satisfaction.

Blue Cross will reward physician groups that stress such preventive measures as regular breast and cervical exams and smoking cessation programs. It will regularly survey patients on the quality of care they feel they are getting and monitor how quickly patients’ grievances are heard and resolved. Satisfied patients will earn doctors substantial bonuses.

The change’s effect on insurance premiums remains to be seen, though Blue Cross expects a fresh emphasis on prevention and prompt referrals to specialists. That certainly has been so with some other HMOs, which early on recognized that cost savings could be achieved--and patients’ lives improved--by identifying and treating problems early.

The test of Blue Cross’ new approach will be in the experience of patients and doctors and what happens with health care premiums. If the quality of care improves, if doctors’ frustrations with the bureaucratic impediments they so often face in practicing medicine decline, if better care does not lead to runaway premiums, Blue Cross will have shaken up an industry sorely in need of reform.