Patients already find limits on choice

April 13, 1994|By John Fairhall | John Fairhall,Sun Staff Writer

As Congress inches toward health care reform, revolutionary changes are transforming America's health insurance system, eroding patients' freedom to choose and keep their doctors.

Employers, seeking to control the cost of employee health care, are pushing workers into cheaper health plans that offer limited selection of doctors and force many patients to switch physicians, sometimes during traumatic times.

For Reine Goldstein, that time came when she was diagnosed with cervical cancer. A 39-year-old mother of three, she wanted her gynecologist and obstetrician of 12 years, Dr. Joseph Moser, to treat her. But her husband's employer had recently changed the family's insurance plan to a health maintenance organization, which limited the choice of doctors and excluded hers.

"So I was forced to leave Dr. Moser, probably at what I consider the most trying time of my medical history, and go to someone I did not have any kind of relationship with and start a different path of healing," complains Ms. Goldstein, a homemaker from Arnold.

Whatever health reform plan Congress passes will almost certainly accelerate the trend. The bills under consideration promote the use of health maintenance organizations and other plans that hold down costs by limiting the selection of physicians, hospitals and pharmacies.

Many states are enacting similar reforms. In Maryland, which already has a greater percentage of people in HMOs than most states, a law that takes effect July 1 is expected to encourage small businesses to buy such plans for their workers.

"There's a tremendous amount of change," says Dr. Haya Rubin, an assistant professor of health policy management and medicine at the Johns Hopkins University. "And it's only going to get worse in the next couple of years."

Most experts predict that the health care system will increasingly shift from traditional plans with a wide choice of doctors to plans like HMOs that require patients to see only doctors in their networks. That means more patients will lose access to their current doctors. But the system is still evolving, and it is unclear to what degree choice of doctors will be curtailed in the future.

Some people are resisting the changes, prompting insurers to offer HMO plans with a greater choice of physicians -- but for an added charge. Doctors and unionized workers are among the fiercest opponents of HMOs. In Baltimore, 400 employees of Poly-Seal Corp. have been on strike for five weeks because they don't want to join the HMO offered by the company.

The Maryland medical society is among many state physician groups that support legislation to force HMOs to open their doors to virtually any doctor. Although a bill supported by Maryland doctors died as the General Assembly session ended Monday, 19 states have passed some form of the legislation, one of which is also expected to be introduced soon in Congress.

HMO advocates alarmed

Alarmed, HMO advocates held a news conference last week in Washington to assert that such legislation would drive up costs.

HMOs try to hold down costs by managing all of a patient's care, from doctors' visits to hospitalization. They recruit physicians who become salaried employees or who agree to provide care for a set fee, usually less than what they receive from traditional insurance plans.

Many consumers praise HMOs for the care they get and the convenience of one-stop shopping.

But the transition from traditional insurance to HMOs and other forms of so-called "managed care" is often wrenching, as Ms. Goldstein found. People frequently are forced to change several doctors -- their primary-care physician and one or more specialists. This can happen when their employer switches to an HMO, when they change employers and again when their doctor leaves the HMO.

Some people, like the Poly-Seal workers, feel so strongly about keeping their doctors that they would rather fight than change.

"A lot of people have been with their own doctor for years, and they don't want to switch," says Pat Hamlin, a 35-year-old union official and mechanic at Poly-Seal, which makes plastic caps and container seals. His wife has been seeing one gynecologist "forever," and their two children have had the same pediatrician for seven years.

But Poly-Seal, like most businesses, has seen big cost increases in health care. The company's health bill shot up 75 percent in the past three years and is projected to reach $4,700 per worker in 1994, says Robert N. Gillman, president and chief executive officer.

"The era of unmanaged health care . . . is over," asserts Mr. Gillman, who believes that the use of specialists must be controlled to restrain health spending.

The percentage of employees in HMOs and other nontraditional health plans shot up from 29 percent in 1988 to 51 percent in 1993, according to a study by KPMG Peat Marwick, the accounting and consulting firm, and Wayne State University in Detroit.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.