Report from the NYTimes 7/14/99
Report Says Profit-Making Health Plans Damage Care
July 14, 1999
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By SHERYL GAY STOLBERG
WASHINGTON -- Patients enrolled in profit-making health
insurance plans
are significantly less likely to receive the basics of good
medical care --
including childhood immunizations, routine mammograms, pap
smears,
prenatal care, and lifesaving drugs after a heart attack -- than
those in not-for-profit
plans, says a new study that concludes that the free market is
"compromising the
quality of care."
The research, conducted by a team from Harvard University and Public
Citizen, an
advocacy group in Washington, is the first comprehensive comparison
of
investor-owned and nonprofit plans. The authors found that on every
one of 14
quality-of-care indicators, the for-profits scored worse.
But because the researchers favor national health insurance, some
questioned their
findings.
"The market is destroying our health care system," Dr. David U.
Himmelstein,
associate professor of medicine at Harvard University Medical School
and the
study's lead author, said in a telephone interview. "We have had a
decade or more
of policies aimed at making health care a business, and they have
failed."
Investor-owned health plans, which are typically made up of loose
networks of
doctors, have come to dominate the American medical landscape in
recent years.
These plans, offered by companies like Aetna, U.S. Healthcare and
Cigna
Healthcare, last year covered 62 percent of all patients in HMOs, as
compared to
26 percent in 1985. Yet most research on quality of care in HMOs has
focused on
traditional nonprofits, among them Kaiser Permanente, in California,
and HIP, based
in New York.
The new study, which appears this week in the Journal of the American
Medical
Association, analyzed quality-of-care data from 248 investor-owned
and 81
not-for-profit plans in 45 states and the District of Columbia. These
plans provided
coverage to 56 percent of all Americans enrolled in HMOs in 1996, the
year from
which the patient information was drawn.
Among the findings: In profit-making HMOs just 63.9 percent of
2-year-olds were
fully immunized, as compared to 72.3 percent in nonprofits.
Lifesaving beta-blocker
drugs were given to 59.2 percent of heart attack patients in
for-profit plans, but 70.6
percent of patients in nonprofits got the drugs. Diabetes patients
were less likely to
receive annual eye exams to prevent blindness in profit-making plans;
the figure was
35.1 percent, as against 47.9 percent in nonprofits.
The investor-owned plans fared worse, the authors said, even when all
other factors,
like location of the plan, and whether the doctors were employees or
members of
networks, were taken into account. While the study had certain
limitations -- it did
not examine patient outcomes, for instance -- the authors, who paid
for the research
themselves, said the data were the best available.
The study is being published just as the Senate is embroiled in a
divisive debate over
how to protect patients' rights and regulate HMOs. While the authors
say the timing is
coincidental, the work is already influencing the discussion. In a
statement released
Tuesday, Sen. Edward M. Kennedy, D-Mass., who is pushing for HMO
regulation,
said the research "contains strong new support for HMO reform."
But representatives of the insurance industry, which opposes
regulation, argue just
the opposite. They say the study demonstrates that, even at their
worst, health
maintenance organizations provide better care to patients than
fee-for-service
arrangements that were common 10 years ago.
"The best conclusion that can be drawn from this study is that
managed care is
improving the quality of health care for those Americans that are
covered by health
plans," said Susan Pisano, a spokeswoman for the American Association
of Health
Plans, which represents both for-profit and nonprofit plans.
Ms. Pisano also accused the authors of confusing "analysis and
ideology."
Himmelstein did not dispute that he has a bias. "My bias is that
for-profit HMOs kill
people," he said.
But Eli Ginzberg, a health care economist at Columbia University who
did not
participate in the study , said Himmelstein's political views did not
discredit his
work.
"There is no question that he has an agenda, but I think he is
reading his data
correctly," said Ginzberg, who said it was hardly surprising that
nonprofit plans
deliver better care. "Let's face it, people went into the for-profit
managed care
business to make bucks."
The study was made public here Tuesday at the offices of Public
Citizen, whose
director, Dr. Sidney M. Wolfe, was a co-author.
