HMO Panel to Call for Consumer Protections
California should strip an oft-criticized state agency of oversight responsibility for HMOs and enact dozens of new protections for consumers to address widespread public dissatisfaction with managed health care, a governor's task force will recommend.
The pending report, which calls for a new state agency to oversee HMOs, is already drawing fire from critics for not going far enough. But it is expected to carry clout in Sacramento and Washington, where controversy over the growing influence of the managed care industry--and doubts about the quality of medical care it provides--have become a highly charged political issue.
Many of the more than 60 recommendations by the 30-member bipartisan panel are given a good chance of being enacted into state law. Its report, assembled over the last several months, is to be completed at the group's final meeting Monday.
The panel called for easier access to medical specialists and prescription drugs, a better consumer complaint process when medical service is denied, requiring HMOs to collect and report more information on medical quality, making it easier for consumers to "comparison shop" among HMOs, and numerous other measures.
But the panel's recommendations provide plenty of ammunition for both proponents and critics of managed care. Indeed, some of its proposals call for looser supervision of the industry than bills passed by the Legislature last year but vetoed by Gov. Pete Wilson.
Several task force members are charging that the panel ducked major issues, that its conclusions were formed without critical information from its own statewide public opinion poll, and that its proposals don't go far enough in protecting HMO members.
And industry officials warned that the panel's recommendations would have the effect of driving up health insurance premiums. The panel, led by a prominent Stanford University economist and Gov. Wilson's chief economist, did not address the effect of its proposals on the cost of health care.
But some panel members who were selected to represent consumer interests--some of whom are frequently critical of HMO practices--saw a lot to like in the recommendations.
"I really think there is a lot of very positive recommendations that can make a huge difference for individual consumers," said Peter Lee, a director at the Center for Health Care Rights, a Los Angeles patient advocacy group.
