Yes. This isn't a black-and-white issue because an HMO might not be the best health-care ticket for a person with a longstanding illness who has been treated for a long time by a specific physician who's not a member of an HMO. I wouldn't tell a person with heart disease to leave a non-HMO cardiologist with whom he or she has had a long, close relationship.
But Medicare patients who don't have a close relationship with a non-HMO physician will generally find they get more benefits at lower cost -- and with less hassle -- if they belong to an HMO.
HMOs have more comprehensive physician benefits, hospital benefits, outpatient-care benefits -- and often dental, vision and drug benefits. A more generous benefits package is ordinarily one of the characteristics of an HMO.
The HMO concept couples comprehensive benefits with health maintenance -- more preventive care than you'd ordinarily find in a standard indemnity package.
Elderly patients are encouraged to attend programs that stress proper diet and exercise.
When I was health-care manager for the Caterpillar Tractor Co., I spoke to about 1,000 Caterpillar retirees about the new HMO that was going to be made available to them. To my surprise, the point that impressed them the most was the absence of claim forms to fill out.
Many of the elderly have trouble with vision and with arthritic fingers. Filling out detailed claim forms can be a terrible burden for them. With the HMO, they have few, if any, claims to fill out.Ronald A. Hurst executive vice president, American Medical Care and Review Association, Bethesda
No. Among 50 HMOs with Medicare contracts, a Minnesota study group found four out of five are losing money on them. And 10 percent say they're going to drop their Medicare patients at the end of their current contracts, while a third are considering it.
HMOs are trying to find excuses to get out of their Medicare contracts. They want young, healthy patients. That's how they make money.
In an HMO, the patient is just a commodity, a way for the corporation to make money.
Minnesota's Physicians Health Plan lost a lot on Medicare patients, yet had to keep premiums down because of stiff competition among HMOs. So it pressured its physicians to cut patients' benefits.
That's happening across the country. HMOs tell their physicians they'll earn more money if they don't refer. The physician loses pay for every referral, X-ray and lab test he or she orders.
That's an incentive to ration care.
According to last April's report by Sen. John Heinz's Subcommittee on Aging, many HMOs try to avoid enrolling Medicare patients by holding meetings at remote sites accessible only by car and establishing facilities far from public transportation.
They recruit clients at senior-citizen organizations with mostly upper-middle-class members. They mail market literature to zip codes with white middle-class residents.
According to the report, the quality of care in many HMOs is completely inadequate. And after initially offering extra benefits for low premiums, they scale down the benefits and raise charges when profits are inadequate.
Long appointment delays, inadequate phone lines, rude and insensitive clerks and intentionally misplaced records are among the indignities HMO patients face. Access to specialists is often made so difficult that they find their own and pay out of pocket.Dr. Ronald Bronow executive vice president, Physicians Who Care; assistant clinical professor of medicine, University of California at Los Angeles