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HMOs Have Altered
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ELIZABETH SCHEIBNER
Special to The Jewish News
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ealth care used to be rela-
tively simple. You chose a
doctor, paid whatever fees
ou incurred and your
insurance company reimbursed you for
most or all expenses.
Today, traditional fee-for-service
health care is almost nonexistent. The
advent of managed care has changed
health care
delivery for-
ever - for
better or
worse. In the
United States
alone, more
than 50 per-
cent of the
work force is
enrolled in a
managed-
care organi-
zation, with
14,000 new
members
signing up
each day. Over the past 10 years,
HMOs have experienced a sixfold
increase in membership, from 10 mil-
lion in 1982 to 65 million today. And
by the year 2000, membership in man-
aged-care organizations is expected to
top 100 million.
Much of what we hear and read
about HMOs is negative, but the reali-
ty is that managed care has reduced
medical price inflation and has made
health costs more predictable. While
there are those who blame HMOs for
what they see as a decline in the quality
of health care, others contend that
managed care offers more extensive
coverage than traditional insurance.
Participants in HMOs typically are
able to take advantage of added ser-
vices, such as home health care, occu-
pational and.physical ,therap; chiro-
practic care, wellness programs, mental
health services, hospice care and more.
One of the notable advantages of man-
aged care is that an HMO pays the
bills directly rather than reimbursing
you, reducing the amount of paper-
work you have to fill out.
Overall, consumer satisfaction with
managed care seems to be high. A sur-
vey by the Chicago Business Group on
Health, for example, 'revealed that 84
percent of those polled were satisfied
with their managed health care plan.
Hy
Elizabeth Scheibner writes for Copley
News Service.
Even so, experts agree that consumers
must now assume greater responsibility
for their health care and be better
informed patients in order to receive
the care they deserve. Over the last
decade, hundreds of managed-care
organizations have sprung up across the
country, each offering different plans
and different coverage. More than half
of all employers contract with only one
HMO, which means that employees
must participate in that plan or pay for
their own
health care.
However,
many large
companies
are now
offering
their
employees a
choice of
health
plans, giv-
ing them
the freedom
to select the
type of cov-
erage that
best meets their individual needs.
Choosing an HMO can be a confus-
ing and time-consuming process, but
it's important to check out a health
plan before signing up. StorieS abound
of people who find themselves con-
fronted with enormous out-of-pocket
expenses because they didn't fully
understand their health plan's coverage
and exclusions.
"The old adage, let the buyer
beware,' holds true for health care as
well as used cars," says John Connolly,
Ed.D., author of the book "The ABCs
of HMOs: How to Get the Best From
Managed Care" (Castle Connolly
Medical Ltd.).
"It is only through becoming
informed consumers that we can know
what we are entitled to and .can then
demand the best when it is not deliv-
ered."
The biggest challenge in selecting an
HMO is finding one that meets your
family's current and long-term needs.
There are many factors to consider,
including cost, convenience, service
and location of physicians. One of the
best ways to assess an HMO is to ask
co-workers and friends if they're satis-
fied with their plans. Find out what
they like and dislike, and ask if they've
encountered any problems.
Additionally, you can ask HMOs to
send you literature describing their
plans.
One thing to consider when choos-
.