A prominent feature of health-care reform proposals now in Congress would forbid the kind of efficient, economical and medically effective balancing of resources that have been developed by the best-organized health-care delivery systems in California.
Health-maintenance orgnaizations and other forms of preferred-provider organizations contract selectively with doctors and hospitals on the basis of quality and cost and arrange health services for their enrollees. They match their resources closely to the estimated health needs of the populations they serve. Through effective management, they make efficient use of hospital beds and of their generalist and specialist doctors. This sort of market-based efficiency, in which California is a pioneer, is what we should be striving toward nationally. But the national reform proposals would force health plans to contract with and include in their networks certain types of hospitals and health providers, even if this is not the most economical or highest-quality care available.
These proposals are rooted in the old "any-willing-provider" laws that forbade health plans to restrict services to certain doctors and hospitals if other doctors and hospitals would accept the same payment and service terms. The restrictions were overturned by California in 1982 and by many other states since.
About 120 million people have chosen to enroll in HMOs and PPOs for reasons of cost, access and quality, and millions more will do so if they are given the opportunity.
The new variations of any-willing-provider laws are limited but equally damaging. For instance, the Administration's reform proposal requires health plans to contract with academic medical centers for specialty care. To ensure quality, health plans should be required only to meet appropriate quality standards; they should not be required to enter a contract with a certain type of provider on the erroneous assumption that it's the only way to provide high-quality care. To the extent that academic medical centers provide high-quality, high-technology and highly complex care, health plans should and do selectively seek their services. But not all academic-affiliated medical care falls into this category, and non-academic centers can also provide high-quality care.
