The HMOs’ Image Problem

Managed care has enjoyed breathtaking growth in recent years, and here in California, where more than 90% of those with insurance are enrolled, “HMO” has becomes a virtual synonym for health care. But a survey released this week makes clear that managed care, while widespread, has a serious image problem.

The survey, conducted by Harvard University and the Kaiser Family Foundation, is the most thorough look yet at public attitudes toward HMOs. It found that 51% of Americans polled said managed care has lowered the quality of health care, and 55% said they worry that their HMO would be more interested in saving money than in providing them the best possible medical treatment.

This negativity clearly could slow the expansion of managed care, which is just gaining a foothold in some states. So HMOs would be wise to work on their image. One suggestion is an industrywide patient “bill of rights,” similar to one recommended last month by a presidential commission made up of consumers, managed care officials and Clinton administration officials.

Among the most important of these rights would be guaranteed payments for emergency room visits if a “prudent layperson” would agree that they were warranted; provision of information on a doctor’s experience in performing a procedure, and an outside review of any HMO decision to deny care that one of its own physicians had recommended. A guarantee of such rights could forestall more intrusive regulation should the backlash against HMOs continue.

The message is not getting through. The HMO industry is launching a media campaign to turn public sentiment against the commission’s recommendations before Congress can enact them into law. That is talking money.

The HMOs could well succeed in their campaign, for the survey also found that 40% of those polled worry that government regulation could raise health care costs. But the industry’s victory would be short-lived, for by defeating attempts to give managed care consumers even a modicum of basic rights, it would only deepen public distrust.