Employers Encourage Managed Care Options for Health Care

Article excerpt

EDITOR'S NOTE: This is the last in a six-part series by L.A. Times Syndicate columnist Kathy Kristof on the national health care crisis. When Jan Gribbon was asked to choose between several health plans two years ago, she went with the most cost-effective option _ a health maintenance organization that promised to keep her healthy and treat her when she was sick.

But Gribbon is no longer a member of the HMO.

"Short of having no health care coverage at all, nothing would get me back into an HMO," said the Los Angeles public affairs specialist. "I know that's extreme. I'm sure there are probably good ones. But I am not willing to risk my health again to find them."

Gribbon is among an increasing number of individuals opting for HMOs in recent years as the result of a corporate push toward so-called "managed care" plans. Although most employers do not demand that workers choose managed care options, they encourage the choice by making it more expensive to choose traditional insurance programs, called indemnity plans, industry experts say.

Companies want their workers to choose HMOs because they are far cheaper, costing an average of $3,046 per employee vs. about $3,573 for an indemnity plan, according to a recent survey by Foster Higgins Co. in Princeton, N.J.

At the same time, companies argue that HMOs _ once little better than health clinics _ have vastly improved. Where these organizations once forced participants to visit a single facility to get health care, many now have numerous health facilities and doctors. Most allow you to choose a personal physician and have a broad range of specialists who can treat you at a fraction of the normal cost.

They can save a fortune for families with children who have frequent checkups and for people with serious ailments because doctor's visits and hospital stays cost only a few dollars.

Still, many consumers are skeptical of HMOs. And horror stories like Gribbon's are the main reason why.

Gribbon ruptured a disc in her back while on business in Orange County. The pain was so great that she was unable to walk or drive. Her husband brought her to her physician in Los Angeles.

A short office visit confirmed what Gribbon already knew. She needed a back specialist. The primary care doctor referred her to a system specialist, but the referral took about two weeks to complete. In the meantime, she was told to take painkillers and muscle relaxants. The drugs made her drowsy, but the pain was still intense.

The specialist ordered a test, which took a week to schedule. When the results came back, the doctor said he needed another test because the first one wasn't the best indicator of a ruptured disk. Why was it done? Because the HMO didn't have in-house access to the test Gribbon needed. And the doctor said he didn't want to go outside of the HMO system. …