Editorial: Quality sure isn’t the norm

Wednesday, April 12, 2000 | 9:46 a.m.

There has been some positive news lately regarding the efforts to get health insurers to be more responsive. Aetna, the nation's largest insurer, on Tuesday agreed to stop rewarding or penalizing physicians in Texas based on whether they limited the care their patients received. Aetna's concession came in its settlement of a lawsuit filed by Texas' attorney general, who argued that these compensation plans were illegal.

Aetna isn't the first insurer to recently change the way it is doing business. For instance, in November the nation's second largest insurer, UnitedHealth Group, announced it would no longer require doctors to get prior authorization to order tests and treatment. And while all of these moves are a step in the right direction, not all insurers are willing to improve the care they provide.

In fact, a troubling report just released highlights the pressure doctors feel to deceive HMOs just to get needed treatment for their patients. A study published in the current Journal of the American Medical Association found that almost 40 percent of physicians acknowledged they had misled insurance companies in the past year, sometimes overstating the severity of the patient's illness in order to get tests or treatments that HMOs normally wouldn't authorize.

Health care in this nation has become a mess. Not only is there inconsistency in the quality of medical care, but the HMOs' obsession with cost-cutting has created a health care system that places an unhealthy emphasis on profits at the expense of patients. The bottom line is that Congress should pass a patient's bill of rights so people can get the proper care they deserve.