Hmos Takes the 'care' out of Health Care

HMOs Take The Ð''Care' Out Of Health Care.

In the early 1990s insurance companies, in attempt to control spiraling medical costs, created what would be termed "health maintenance organizations", also known as HMOs. What HMOs do is create a team of physicians and medical personnel that the patients agrees to use. Within the contracts both the patient and the doctor sign, limits and restrictions are put on what the hospital will reimburse and what they will or will not provide in order to keep the costs down. At the beginning, these organizations were successful in bringing medical costs down and has made health insurance more affordable than ever. However, the contracts that the HMOs have you sign basically limits the doctor on how he or she can treat their patients, thus putting their job as the physician in the hands of the HMO. As profits began to go up and down these organizations have put more effort into keeping their costs down and have lost sight of actually caring fir the patients they are insuring.

To prove my thesis in this paper I will discuss how our senior citizens and the chronically ill have been hurt by recent cuts their HMOs have made. I will discuss the many reports of HMO negligence and the issues concerning the patient doctor relationship. I will also go into what actions, or lack thereof, our government has taken in response to HMO woes. All of these points will show that HMOs have lost the concept for caring for their patients including our elders who are one genre that are being hit hard by the actions these HMOs have taken.

In January of 2001, nearly one million senior citizens were kicked out of their Medicare health plan ("What's Behind" 1). Why have so many HMOs dropped these health plans? The reason why is because these Medicare programs are for the elderly only and simply were not profitting, and in response, the insurance companies shut them down. The HMOs claim that federal reimbursement levels were not keeping up with the medical cost inflation forcing them to cut these programs. For instance, in 2001, the government's reimbursement to the HMOs went up only 2 percent while the insurance company's costs went up between 11 and 13 percent (par.3). Though the reimbursement level issues may have contributed to the HMOs decision to cut these programs they are just the surface to the problem. Back in the mid-1990s HMOs began purposely enrolling more senior citizens in their mid-60s who did not require as much medical attention as do people in their mid-80s. This made it so that the younger senior citizens were covering the costs of the older ones while the HMOs cashed in. This worked out well for the HMOs until there was a sudden increase in the average age of their patients and costs began to skyrocket, thus leaving one million of our elders with out health insurance.

Senior citizens are not the only ones struggling with their HMOs. Many people of all ages, races, and gender are struggling with the health insurance. These problems can be summed up to the simple fact that the HMOs simply do not care about the patient anymore. For instance, few HMOs have special disease management programs, though they have proven to be very cost effective. These programs are targeted directly to the disease of the patient and are more then just a visit to the doctor every so often it involves every aspect of treatment such as the nurses, pharmacist, rehabilitation and so on. To the HMO this makes chronic conditions, such as cancer, non-profitable because they require a lot more medical treatment than the average. Therefore many doctors' HMO dissuade their patients from seeing specialists. In order to see a specialist, the patient needs a written referral from their "primary physician". Ron Henderson, who had been getting pains in his chest and through out his arms. When visiting his doctor, his file showed an irregular EGK and a previous heart attack. The doctor ignored this and diagnosed Henderson with a hiatal hernia and failed to send him to a heart specialist. Ron would die of a heart attack later that year. Kaiser Permanente insured Henderson; one of Americas longest withstanding HMO. Kaiser is present in 17 states including Texas where in 1993, nine heart attacks, including Mr. Henderson's, were misdiagnosed under care given by Kaiser (Tuleya 2). Kaiser would settle out of court with the Henderson family for $5.3 million contributing to the approximately $270 million Kaiser lost in 1997 (3).

Kaiser Permanente is not the only HMO that has had issues with medical negligence among their patients. A report in May of 2001 revealed that HMOs and hospitals have basically ignored a federal program that requires them to report medical incompetence. The purpose of this program is to keep information on doctors in a computer system known as the National Practitioner Data Bank so that patients can know of their physician's history of incompetence and/or bad health care. Some examples of incompetence include performing surgery on the wrong side of the body, sexual relations with patients, and doctors prescribing narcotics to ones self(HHS:HMO par. 10). The HMOs failure to follow these guidelines and let the patient know if the care they are receiving is of good quality further shows the HMOs true lack of care for the patient. The report shows that in the 1990s eighty-four percent of HMOs and sixty percent of hospitals did not report one case of medical incompetence. A survey in July 2000 showed that between 235,000 and 284,000 deaths were doctor-caused. This places medical incompetence third to cancer and heart disease as our nations leading cause of death ("HHS:HMO" par. 5). At first glance those just seem like more numbers. However, deeper into it, that is nearly 300,000 people whose family and friends mourning over a loved one that could have lived if HMO limits would not have prevented the health care provider form giving proper diagnosis and/or treatment. I believe this issue should most definitely be higher on our list of priorities and be very closely recorded.

In A.J. Tuleya's article "The HMO Dilema" she discusses Saving the of Medicine by Margaret A. Mahony, where Mahony writes about the many stories of HMO struggles and strongly believes that HMOs are nothing but a scandal. One of her stories involves a woman who had been seeing seven different medical personnel in attempt to find out what was causing her chronic disabling pain. After two years of no success the woman was forced to go outside of her HMO so that she could see a specialist her insurance wouldn't cover (Allger par. 5). Explaining the purpose for writing this book Mahony stated,

"One purpose of this book is to highlight the contemptible consequences of managed health care. This intimate view