Are You Getting Good Care?

During the last several years, researchers have begun to ask consumers across the country about their experiences with health plans and with the physician groups with which the plans contract to deliver care. How often do you get the care you need? How timely is it? How long do you have to wait to see a doctor? How often do you have trouble getting in to see a specialist? The answers to these questions are used to chart broad comparisons of health plans and doctors' groups.

The surveys have prompted providers and insurers to improve services, some researchers believe. "Over the past few years, in HMOs we've seen steady improvement in several measures," including treatment of high cholesterol and diabetes, says Clark Miller, a spokesman for the Pacific Business Group on Health, an alliance of some of California's biggest employers, which helped develop the HMO Report Card and the Medical Group Performance Scores chart.

Both tables offer crude, overall measures of performance and should be considered only a first step in judging a health plan or physicians' group, Miller says. More detailed information on HMOs and physician groups will soon be available on the business group's Web site, http://healthscope.org.

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California HMO Report Card

Key: POOR ( 0 ); FAIR ( 1 ); GOOD ( 2 ); EXCELLENT ( 3 )

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Living Doctor Staying Getting With Communicn Plan Healthy Better illness & Service Service Aetna U.S. Healthcare-South 2 2 2 2 1 Blue Cross of Cal. HMO-California Care 2 2 1 2 1 Blue Shield of California HMO 2 2 1 2 1 CIGNA HealthCare of California 2 2 2 2 1 Health Net of California 2 2 1 2 2 Inter Valley Hlth Plan 1 (a) 1 2 1 Kaiser Permanente- South 2 2 2 2 2 Maxicare (1) 1 1 1 2 1 PacifiCare of California 2 2 1 2 1 Universal Care (a) (a) (a) 2 1

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Source: Compiled from 2000 patient surveys, administrative records and medical records. Courtesy: State of California; Office of the Patient Advocate; Business, Transportation and Housing Agency

(1) Due to financial problems, HMO is now being run by state regulators.

(a) No info

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Consumer Ratings of Medical Groups

In 2001, patients in Southern California medical groups were surveyed to find out how they rated the quality of care they receive in their medical groups. Questions addressed patient satisfaction with care, the ease of getting referrals to specialists, quality of care for routine and serious illness or injuries, and how well doctors provided recommended preventive care.