On Aug. 23, J. E. McNeil called the ear, nose and throat department of the Group Health Association, which she had just joined, complaining of one of the classic warning signs of possible cancer -- a lump, which happened to be in her throat.
"The woman said, 'Is it bothering you?'" recounted McNeil. She told the receptionist, "Well, it doesn't hurt or anything, but I had surgery for cancer with another lump before and I want it checked out."
McNeil's earlier lump had turned out to be benign, as the new one may be. But physicians at Group Health will not know that until after Oct. 30, the day she was scheduled for an appointment -- 10 weeks after her call.
Officials of GHA, the area's largest prepaid health care plan, say McNeil should have been seen within a week of her call.
At the same time, however, they say that appointment delays are intentionally built into the GHA system.
"To fully respond to the demands of every member would create costs that would be unacceptable to the majority of members," said Dr. Edward J. Hinman, executive director of Group Health.
When a patient is covered by a conventional insurance plan, he usually has to pay a portion of his medical costs himself. This not only keeps insurance costs down, but makes the patient think twice before seeking care.
The waiting time at GHA, say its officials, is designed to control costs the same way.
GHA'S 110,000 members pay an annual premium that covers all their visits to the group's staff physicians, tests and hospitalization. Thus one visit to the doctor would cost the same for an appointment, he may decide he does not need it.
During the past six months GHA members at times have found themselves waiting more than 12 weeks for routine obstetric and gynecological appointments.
"We had a significant backlog of routine visits [for such patients]," said Hinman. "As best we could tell, we should have 14 [physicians in the department] and we had about 9. We have 16 now and the system should be pretty much caught up to where they can get in for a routine visit in 10 to 12 weeks."
"But the impact of increasing the staffing in (obstetrics and gynecology) is going to be felt in the 1980 budget," said Hinman. But that impact has not been determined yet.
"The way we're approaching it is we're trying to set some standards for waits for appointments," he said. "Are our members willing to wait (for appointments) to control costs?Are they (unwilling to wait and) willing to let health care costs go up to 12 or 15 percent of the gross national product?"
Officials of the 16,000-member George Washington University Health Plan say its patients face waits of up to eight weeks for routine visits.
Dr. Joseph Miller, the prepaid group's medical director, said, "If you were going to have to pay $25 to see Joe Miller, you might just wait to see if your cough was going to get worse, or was just a common cold. But if you have open access to care" and don't have to pay, "you're not going to wait" to go in unless it's impossible to get an appointment.
As the British national health service developed, Miller added, waits for nonurgent care became longer and longer as it became impossible to pay for the system's keeping up with demand.
"I think the quality of care can be as good in a prepaid plan as in private practice," said Miller "but it's not instant."
A GHA committee is now trying to examine the expense of reducing the wait, said Hinman. The present goal is to have every new member in for a physical within six months of joining and reduce the waits for a checkup to eight weeks, a "nonurgent" problem to two weeks and an "urgent problem," such as the flu or a strep throat, to 24 hours.
Group Health has "minor injury unit" at its Northwest Washington facility that operates like an emergency room, and any patient who believes his problems needs immediate attention can go there, Hinman said.
Additionally, they are provisions in the GHA contract for members who feel they need immediate medical care, but cannot get it within GHA, to go to a private physician and then submit a bill to GHA. The bill is then reviewed by a GHA committee to determine how much, if any, of it will be paid.
"Philosophically," said Hinman, "people can deal with" waiting longer to save money. "The problem comes when they feel bad."
But about two-thirds of the problems for which patients seek help will evenutally go away with, or without, medical care he said.
Waiting times of a week or two for tend to reduce the number of patients visits, Hinman said, because many minor illnesses will disappear before the day of the appointment.
"From a national perspective," Hinman said, "the real issue is how are we as a nation going to do everything we want for ourselves and still pay for it?"