Many HMO policies remain inadequate

On Monday, the United Health Group, a Minneapolis-based health-maintenance organization, announced that its physicians would regain control of important medical decisions affecting their patients. United Health’s decision is certainly a significant improvement over current industry practice, and the organization deserves credit for its responsiveness to innovations. However, more innovations within the industry are necessary, as many current HMO policies are similarly inappropriate and deserve similar reforms.
For many years, HMOs have prioritized concern for the overall health of the organization over proper and thorough care of the patients. United Health’s decision will allow doctors to determine and apply appropriate care to patients without consulting with company advisers prior to giving treatment. Physicians will now be evaluated over longer terms to determine if their practices are wasteful, rather than having each treatment individually evaluated. Traditionally, companies have recommended the least-expensive solution for patients, rather than the solution that would be most medically appropriate.
In addition to giving doctors the final say on treatment, patients must also have the right to sue HMOs for medical malpractice. Because of their vast bureaucracies, policies and decisions made within HMOs often neglect the patients, and appropriate care is sometimes denied to them because of high associated costs. When HMOs directly or indirectly affect patients’ care in a negative way, patients must have the right to seek compensation.
Patients must also have the right to choose the physician by whom they want to be examined. The relationship between patients and physicians must have mutual respect and trust to ensure the best application of treatment. Under some HMOs’ policies, patients must choose their physician from a list approved by the organization. A patient who wishes to be examined by a physician not affiliated with the HMO is either not allowed to do so, or the patient must pay an additional fee. This policy is likely to harm the patient’s health, as many individuals are very uncomfortable discussing medical problems with an unfamiliar doctor.
HMOs must also provide an appropriate forum for understanding patients’ complaints. Inadequate care, relationships with physicians that inhibit effective treatment and service complaints must be understood by the organization, and appropriate compromises should result. Panels that operate independently of the organization are currently required in 30 states and are a significant measure in legislation currently awaiting approval in joint House-Senate conference committees. HMOs should encourage this trend rather than fighting against independent oversight.
United Health’s decision follows several recent announcements by other companies. United, Aetna, Inc. and some Blue Cross affiliates have agreed to certain improvements in care. However, it is imperative for all HMOs to improve, not just a select few. There must be significant changes in current industry practices to guarantee patients receive effective and appropriate treatment.