Article excerpt

HMO puts choices where they belong

One leading HMO has made a discovery that will change American medicine: It costs no more to please doctors and patients than to annoy them.

That is the surprising finding that prompted UnitedHealth Group to end the practice of reviewing doctors' requests to test and treat their patients. United, the nation's second-largest HMO, will begin giving doctors the final say on patients' course of treatment. Physicians will no longer have to seek approval from the HMO before prescribing care, in most cases.

When HMOs and other forms of managed care started in the 1980s, they used the approval process to scrupulously control the cost of medical treatment. It helped them deliver on their promise of affordable health insurance.

Unfortunately, it backfired. Doctors intensely disliked justifying their treatment recommendations to HMO clerks with no medical background. They chafed when HMOs denied patients necessary care, or gagged them from telling patients about available options.

Consumers became wary as they began hearing horror stories about managed care. Word began circulating that patients were undergoing unnecessary pain, even dying, because HMOs refused to pay for care.

United says it is doing away with the approval system because it costs $100 million a year to run. That system is approving 99 percent of doctors' requests, so the denials don't make up for the administrative costs.

One also wonders whether Congress' and several states' attempts to establish patients' bills of rights were a factor in United's decision to leave decisions to the doctors.

As United dismantles the system, it plans to keep costs in line by tracking what individual doctors order for their patients. It will strike from its network doctors whose spending it deems wasteful.

That is a practical and fair way to keep costs down. It also counters critics who fear that giving doctors carte blanche to treat their patients will drive up the price of managed-care premiums.

Let us hope that United's move works as planned, and that costs and premiums remain stable. …