Health Crisis

Patient bill of rights will curb HMOs' power

Under the current system, many Americans remain unsure of the procedures, medications and physicians covered by their health plans. In addition, many patients discover - only after receiving care - that their HMO refuses to defray the treatment costs. Many patients receiving emergency room care often find themselves confronted by such a predicament. Sadly, in these situations, patients have no effective avenue of petitioning the HMO's refusal. In an effort to empower patients with the opportunity to have their grievance heard by an impartial body, the forthcoming patient rights legislation seeks to establish an appellate panel to rule on patient complaints.

Such an appellate procedure would constitute one of the first major controls on the power of health maintenance organizations. The need for such a protocol for handling appeals has become increasingly evident in recent years. Unchecked, HMOs have gradually eroded the coverage extended to clients in an effort to contain operating costs and maintain profits. The cost-cutting measures have unfortunately led to a general decrease in the quality of Americans' health care plans. Many patients now find new and effective medications unavailable because HMOs may spend many months determining whether they wish to cover a new drug for clients. Also because of cost-cutting, many mothers now find themselves unable to spend a night in the hospital after giving birth.

While the forthcoming legislation seeks to improve health care access and control HMO power, legislators must take care not to defeat the original purpose of health maintenance organizations: To lower the cost of care. The proposed overhaul and regulation of HMOs has the potential to drive up health care costs and spark appreciable inflation within the health care industry, making health care less accessible to Americans. Theoretically, stringent and severe regulation would further patients' cause; however, Congress must keep a wary eye toward maintaining economic stability within the health care market.

Given the current dissatisfaction many patients express with the coverage provided by their health maintenance organizations, the need to adjust and regulate some of their practices is evident. The pending proposal's empowerment of clients and the clarification of basic entitlements would serve to eliminate much of the distress and confusion stifling the smooth growth of the HMO industry. While taking care to protect the affordability of AmericaÕs health care, legislators should support the drafting of a patient bill of rights.

06-01-98