Another year of turmoil ahead HEALTH CARE

January 01, 1995|By John Fairhall | John Fairhall,Sun Staff Writer

It is perhaps for the better that dear old Dr. Marcus Welby is no longer with us. The health care industry in 1995 would seem to him a marketplace version of Bosnia, with insurers playing the role of the aggressor against besieged doctors, hospitals and consumers.

While insurance companies cast themselves in a better light, all sides agree that the revolution under way in the health industry is far from settled. Expect the following in the new year:

* Efforts by Congress and the General Assembly concerning the uninsured, the rights of health maintenance organizations vis-a-vis doctors and patients, and the rising cost of the Medicaid and Medicare programs.

* Continued moderation of health care prices and insurance premiums. Employers and consumers nonetheless may demand even better deals in an increasingly competitive market.

* Creation of hospital and doctor networks to achieve higher efficiency and to fight insurers for a bigger share of the money paid by employers and consumers.

* Increasing growth of HMOs, in which 25 to 30 percent of Marylanders are already enrolled.

"I think 1995 should be another pretty good year for the [HMO] industry as a whole," said Kurt Funderburg, an analyst with Ferris Baker Watts in Baltimore.

The Maryland insurance market will be driven in no small part by what Mr. Funderburg terms the "very aggressive" tactics of Blue Cross and Blue Shield of Maryland. Rejuvenated by President William L. Jews, the state's biggest insurer is challenging competitors for customers, slashing costs and trying to win regulatory approval to sell stock in a new HMO company.

But Blue Cross may cause itself future problems with its proposal to cut specialists' fees by as much as 25 percent. It's the last straw for many doctors, who through the state medical society are exploring the possibility of creating a physician-run health care network that would take business away from insurers.

Congress could instigate far-reaching changes in the health industry if the new Republican leaders can decide: Should it give governors flexibility to tailor state health reform plans at the expense of national employers now exempt by federal law from many state insurance requirements?

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