Editorial: Another reason for HMO reform

Thursday, Sept. 24, 1998 | 10:10 a.m.

MANAGED care supporters have objected to the horror stories used by those who advocate HMO reform, contending that anecdotes don't paint a true picture of the quality of care that patients receive under health plans.

Although opponents suggest they value statistics over horror stories, a new survey full of statistics will make them long for the days of anecdotes. An annual quality survey of managed care plans released Wednesday shows that a wide disparity still exists nationwide when it comes to clinical care and customer service.

The National Committee for Quality Assurance, which collects data on managed care plans, looked at complaints involving access to care and choice of doctors. It also examined the actual care received by patients, including preventive measures.

For example, in the best health plans, 81 percent of older women had mammograms to screen for breast cancer in the past two years. But in the worst plans, the rate for mammograms was just 62.6 percent. In another category, 83 percent of 2-year-olds had received all of their immunizations in the best plans. The worst plans had an immunization rate of just 46.6 percent.

The data released in the survey is intended for employers to make an informed decision as to which HMO to select. Although this vital information is available, it's disturbing that so few employers use this information or share it with their employees.

For instance, studies done for the nonprofit Commonwealth Fund, a research group, found that just 11 percent of the employers using managed care share this quality data with their employees. In addition, only 15 percent of large companies even bother to get accreditation information; only 9 percent of employers require their managed care plan to be accredited.

It's frightening that employees -- and their employers -- remain in the dark about the quality of care they receive. The lack of information, along with the decline in care, is why so many Americans believe managed care reform is essential.

These latest statistics show a disturbing disparity among health care plans, adding just one more reason why reform is needed, giving patients the rights they deserve.

But Congress is set to adjourn in a few weeks and managed care reform, which in 1998 had its best chance for passage in years, is likely to die. It's shameful that Republicans in the Senate refuse to take action on managed care reform.