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Health Care Plans (hmo/ppo) In Orange County

January 30, 1988

According to Johnson and Johnson Health Management, Inc., a Santa Monica-based firm, health care insurance premiums "rose drastically in the 1980s, flattened out in 1984 and began to soar in 1986." During the period, premium rates increased from a low of 12% to highs of 60-70%, said Ron Goetzel, director of data analysis and evaluation.

Cost shifting measures due to higher deductibles, co-insurance payments and out-of-pocket expenses will continue to increase premium rates. "The out-patient setting concept was developed to provide services at lower rates than hospitals, however these costs are increasing. At the same time, hospital rates continue to escalate with fewer people using these facilities. The only way to cut costs is to promote and operate effective wellness and disease prevent programs," Goetzel said.

Based on a report, "Orange County's Health Care Crisis," published by the Health Task Force of United Way of Orange County, the types, amounts and costs of health care programs are determined by current levels of governmental services and augmented by voluntary and private programs. The report estimates that health care deprived persons constitute 360,000 or 16% of the county's 2.15 million population.

According to the report, the health care-deprived fall into the following categories:

FOR THE RECORD
Los Angeles Times Friday February 5, 1988 Orange County Edition Orange County Life Part 9 Page 2 Column 4 Metro Desk 1 inches; 35 words Type of Material: Correction
The listing of health care plans that appeared on the Clipboard page Jan. 30 contained the incorrect number of subscribers for FHP, Inc. The health maintenance organization, headquartered in Fountain Valley, has 99,437 members in Orange County.

Insured Seniors--Medicare, the federal program financed by payroll taxes, general funds and beneficiary payments, insures an estimated 95% of the county's 300,000 senior citizens. Medicare provides basic health protection. However, the program only covers 38% of all health care expenditures because of deductibles, co-payments and non-covered services.

Financially Assisted Residents--MediCal, the federal/state, 50/50 financed program for which the county administers financial eligibility is designed for persons receiving financial assistance (Aid to Families with Dependent Children, Supplemental Security Income or in-home supportive services) for living expenses.

Medically Indigent Adults--Indigent Medical Services (IMP) is a state-financed, county-administered health care program for adults who cannot afford to pay and who are not eligible under MediCal.

Medical Marginals--Thousands of economically deprived county residents receive some type of health care other than the aforementioned programs. However, thousands do not.

Great Uncounted--Little data exist to clearly show persons rejected from health care services, as well as those refusing to seek services because of financial and/or personal reasons.

HEALTH MAINTENANCE ORGANIZATIONS

Health Maintenance Organizations (HMO) are organized health care delivery systems that assume responsibility for health care, financing and delivery to enrolled members. HMO's use pre-paid funds, paid on behalf of enrolled members to support staff and facilities serving membership.

Organization / Name of Plan: AETNA Partners Health Plan

1745 W. Orangewood Ave.

Orange

(714) 634-1988 Number of County Plan Members: 1,778 Total Number of Plan Members: 53,614 statewide Number Primary Care Providers *:331 in county Participating Hospitals/Facilities in Orange County: 12 hospitals; 37 medical groups and laboratories Organization / Name of Plan: Blue Cross of Calif. Take Care Plan

575 Anton Blvd. 200

Costa Mesa

(714) 641-1201 Number of County Plan Members: 1,000 Total Number of Plan Members: 167,000 statewide Number Primary Care Providers *: 40 in county Participating Hospitals/Facilities in Orange County: 3 hospitals; 10 medical delivery sites Organization / Name of Plan: Blue Cross of Calif. California Care Plan Number of County Plan Members: 10,320 Total Number of Plan Members: 120,412 statewide Number Primary Care Providers *: 440 in county Participating Hospitals/Facilities in Orange County: 13 hospitals; 29 medical delivery sites Organization / Name of Plan: Care America

20520 Nordoff Ave.

Chatsworth

(800) CARE-4-US Number of County Plan Members: 6,000 Total Number of Plan Members: 32,500 in So. Calif. Number Primary Care Providers *: 1,000 in county Participating Hospitals/Facilities in Orange County: 7 hospitals in county; 44 hospitals statewide Organization / Name of Plan: CIGNA

4141 MacArthur Blvd. 201

Newport Beach

(714) 253-6900 Number of County Plan Members: 75,000 Total Number of Plan Members: 441,000 in So. Calif. Number Primary Care Providers *: 502 in county Participating Hospitals/Facilities in Orange County: 10 hospitals; 7 medical delivery sites Organization / Name of Plan: Family Health Planning (FHP)

9900 Talbert Ave.

Fountain Valley

(714) 963-7233

Number of County Plan Members: 9,437 Total Number of Plan Members: 171,000 statewide Number Primary Care Providers *: 130 in county Participating Hospitals/Facilities in Orange County: 1 hospital; 7 medical delivery sites Organization / Name of Plan: General Med

701 S. Parker, 4000

Orange

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