Headlines
As reported by the San Francisco Chronicle, November 2, 2005.
On Health Care: Not All Health Plans Are Equal
By Davis Liu
Given an opportunity to select between good health and great health, which would you choose? I'm not referring to the daily decisions on what to eat or how much (or little) to stay healthy, but that dreaded choice we make every year during open enrollment for health insurance. Although selecting a health plan seems like a roll of the dice, we shouldn't gamble with our health, particularly when reliable information is available.
Recently, the National Committee of Quality Assurance teamed with U.S. News & World Report in releasing the annual rankings for the best health plans in America. Not surprisingly, there are tangible differences in terms of quality and service among health plans regarding patient satisfaction with their physicians and care, childhood immunization rates, timely care for pregnant women, mammogram screening rates and the level of care provided to diabetic patients. Had all health plans performed as well as the nation's best, NCQA estimates that last year, 83,000 deaths (twice the seating capacity of SBC Park) could have been prevented. The top-rated plans have programs, systems and incentives in place so that physicians can improve the health of the chronically ill and also those of us who are healthy but often too busy to remember do the preventive screening tests.
Although the report found that the overall quality of health plans has improved over the past six years, it identified some troubling trends. The majority of Americans still mainly rely on family and friends to choose health-care plans instead of using objective sources and report cards. This can be problematic. While 43 percent of Baby Boomers with parents age 65 or older say that their parents would turn to them or other friends and family for health insurance information, 43 percent also feel they know "next to nothing or nothing at all about health insurance to help their parent."
In addition, there is little performance data on the more popular preferred-providers organization plans, because traditionally they have not been as accountable to state and federal agencies, or the media, as HMOs and point-of-service plans.
Finally, as more of us shoulder the costs of health insurance and new high-deductible health-care insurance options, do we truly understand what we are getting, or is it buyer beware?
What I found most troubling was a conversation I had with my sister-in-law. A recent Wharton graduate who had landed her first job, she selected her health plan based on the lowest premium, figuring that because she was young and healthy, she wouldn't need to use it. She didn't realize that her plan scored the worst among members and those trying to access medical care. With 1 in 10 Americans treated annually in emergency rooms for nonfatal injuries, there is a chance she will discover whether this was a good choice. The disturbing thing is that she, like many of us, assumes that all health plans are created equal.
This year, consider selecting your health plan the same way you purchase other goods and services, by doing some research and choosing wisely. Look to other sources of information to help you choose. Besides the NCQA report (www.ncqa.org), the California Office of the Patient Advocate provides quality-of-care report cards for medical groups and HMOs in California (check out www.opa.ca.gov). Don't be shocked if you discover that your medical group had "too few patients to report," was "not willing to report" or chose not to report when it was evaluated on whether the right medical care was delivered.
Investing a few minutes of your time might prevent an unnecessary premature death. At a minimum, it could help you make the difference in whether you have good health and great health.
Dr. Davis Liu, a graduate of the Wharton School of Business and the University of Connecticut School of Medicine, is a practicing primary-care physician who lives in Sacramento. He can be reached at davisliu1@gmail.com.