Quality of Health Maintenance Organizations Questioned

Article excerpt

When health maintenance organizations (HMOs) were invented two decades ago, the prime objectives were to extend health care coverage to more people and hold down costs.

In many ways, the plan has worked reasonably well. Lately, however, some health care experts have begun to question the extent as well as the quality of care available under the various health maintenance organization plans.

During the early years of their development, employers were urged to offer options to workers - health maintenance organizations or traditional insurance coverage. Where health maintenance organizations enrollment was possible, many employees abandoned conventional insurance, despite an oft-voiced fear that individuals would be surrendering the right to choose their own physicians.

Although the issue may have been raised in the early infancy of health maintenance organizations, few, if any, ever questioned an organization's ability to deliver adequate care. Today, it appears, the optimistic assumptions of yesteryear are under challenge.

An overriding concern, as measured by a new medical study, is whether financial pressures are compelling doctors to save money by withholding necessary care.

A report in the New England Journal of Medicine suggests that a number of rewards and penalties are being used by health maintenance organizations to influence the patient care behavior of physicians. As a cost-saving measure, the journal reports, many organizations tie the incomes of the doctors to the expenditures on patients.

The study was conducted by a physician, Dr. Alan L. Hillman of the University of Pennsylvania.

"Certain financial incentives, especially when used in combination, suggest conflicts of interest that may influence physicians' behavior and adversely affect the quality of care," he concluded.

Others agree that the financial incentives exist, but say it's unclear what impact they have.

Even Hillman concedes that financial motives won't prevent doctors from offering the right care when medical needs are obvious. …

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