Newspaper article THE JOURNAL RECORD

Consumers Find New Choices in Health Care Industry

Newspaper article THE JOURNAL RECORD

Consumers Find New Choices in Health Care Industry

Article excerpt

EDITOR'S NOTE: This is the first of a two-part article. President Clinton's sweeping health reform measure may have died in Congress, but that doesn't mean it's business as usual in the medical field.

The threat of health reform and the seemingly endless discussions about shortcomings in the nation's health care system have spurred changes in insurer, corporate and consumer behavior, experts say.

Insurers are increasingly killing "pre-existing condition" clauses that denied coverage to people with recurring ailments, for example. Many companies are changing employee health care options _ and taking greater pains to explain them. Meanwhile, individual consumers have become increasingly skeptical _ more likely to question medical costs and the necessity of certain tests and treatments.

Some savvy individuals are also actively shopping around, recognizing that the cost of different medical procedures can vary widely even when the quality of care is the same.

Now as so-called "open enrollment" periods are starting at many companies, millions of American workers will see the tangible results. For the first time in more than a decade, most workers will find that the cost of their company health plan has either remained level _ or fallen. That's a stark departure from past years when health premiums jumped significantly year after year, health care experts say.

"Almost all of our clients are seeing little or no increase in their cost of health care," said Robert B. Cliff, principal at A. Foster Higgins Co. in Century City, Calif. "It's remarkable. It's happening all over the county. The 1995 increases are nil."

Still, many experts note that company-sponsored health benefits continue to shift, largely in ways that encourage the use of so-called "managed care" options. Managed care programs aim to reduce costs by directing workers to specific health care providers, who have agreed to accept cut-rate fees for steady business. But these programs vary widely in what they provide and how they provide it.

The bottom line: During this open enrollment period, it pays to take a close look at the costs and benefits of your various health care options _ even if you haven't switched health plans in years.

(Companies that offer health plans usually have open enrollment periods once annually, where workers can drop, start or change their health coverage. There's no requirement that these periods be held at any particular time of the year, but most companies that have calendar year ends hold open enrollment in late October or early November, so changes can go into effect at the beginning of January.)

To illustrate how your out-of-pocket health costs can be affected by the plan you choose, I've constructed a hypothetical family _ John and Jane Jones and their two children, Jim, age 4, and Jake, age 6.

All four see the doctor once annually for checkups. For simplicity's sake, we'll say the cost of each checkup is $150, including lab tests and-or eye examinations. The kids also required a total of three office visits and three prescriptions. The cost of each office visit is $50; the prescriptions were each $25.

During open enrollment period, John is able to choose among three health care options: an indemnity plan, that allows unlimited choices but is fairly costly; a health maintenance organization (HMO), which restricts choices but is less expensive, and a preferred provider organization (PPO), which pays a high portion of medical expenses when you see participating doctors and a smaller portion when you seek care outside the network system. …

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