Hands-on health care is an odds-on favorite

Kiplinger's Personal Finance Magazine,  Feb, 1999  by Melynda Dovel Wilcox

• E-mail
• Print
• Link

A backlash among patients against the bureaucratic and restrictive practices of managed care should give a big boost to federal health legislation intended to bring the personal touch back to medicine.

Last year a patients' bill of rights just barely lost in the House. This year the issue is a high priority for both Democrats and Republicans, assuming there's time to take up the issue during this session of Congress before the start of the 2000 presidential campaign. More than half the states have already passed some kind of bill-of-rights legislation.

Patients will get more power. There's bipartisan agreement on a number of provisions: more direct access to specialists, a "prudent layperson" standard for coverage of emergency care, the right to appeal denied coverage to an independent panel of doctors, and a ban on "gag rules" that restrict what doctors can tell their patients.

"The major sticking point will be patients' ability to sue managed-care plans for the consequences of their medical decisions, and not just the cost of care," says Dr. Richard Levinson of the American Public Health Association. That kind of liability would drive up health-insurance premiums substantially, critics say. With premiums already increasing by 4% to 12% in 1999, some of the legislation's more costly and controversial provisions may be dropped, says Richard Sorian of the Georgetown Institute for Health Care Research and Policy.

HMOs are feeling the heat. Faced with negative public opinion (especially in cases where care has been denied) and the threat of legislation, many HMOs are changing their procedures voluntarily. For example, the California Association of Health Plans recently announced that it would require its members to offer an independent appeals process for dissatisfied patients. Eighteen states already require health plans to provide that.

The feds are taking action on their own. Even if legislation stalls in Congress, the Department of Labor has proposed regulations for all employer-sponsored health plans that would cover some of the same bases. Plans would have to respond to urgent appeals by patients within 72 hours, for instance.

The new rules would also address complaints about preauthorization procedures, so that, for instance, patients who were not able to seek preauthorization because they were unconscious could not be denied coverage.

"It's possible that the mixture of voluntary compliance and federal regulations may address many of the concerns that people have been raising," says Mark Hamelburg, a lawyer with William M. Mercer, a benefits consulting firm.

COPYRIGHT 1999 The Kiplinger Washington Editors, Inc.
COPYRIGHT 2000 Gale Group