Surveys Show Troubles With HMOs

K. Woznicki


      Two new surveys quantify what many Americans and health-care providers have already voiced: health maintenance organizations are not providing the best services to ensure quality health care.
      The Kaiser Family Foundation surveyed 1,053 doctors and 768 nurses by mail between February and June of this year. The survey found 87 percent of doctors said their patients were denied coverage during the past two years, including 79 percent who said they had trouble getting approval for a drug they wanted to prescribe.
      The Kaiser survey also found patients had difficulty getting a diagnostic test approved, and trouble seeing specialists and getting mental health or substance abuse referrals.
      More than one-third of the doctors questioned said that denial of coverage had resulted in a serious decline in health, the Kaiser survey found.
      The National Committee on Quality Assurance conducted its own survey, which evaluated 523 health plans offered by 247 insurance companies. Overall, health plans in New England were rated the top performers and health plans in the South Central region of the United States were rated the worst.
      The report found 26.5 percent of patients covered under the health plans studied had trouble seeing a doctor they preferred or obtaining referrals to specialists. Patients gave higher approval ratings to individual doctors and nurses than to health plans, according to the report.
      The surveys highlight the growing dissatisfaction with managed care that currently is being addressed on Capitol Hill. Both Republicans and Democrats have been pushing for their own versions of legislation to improve patient care.


HMOs Return
HMOs Return