The Problems With Hmos Essay Research Paper — страница 3

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us, and does happen everyday. HMOs cost cutting has a devastating impact on both the born and the unborn. In Louisiana, when Florence Corcoran entered her eighth month of what had been considered a high-risk pregnancy, it had been recommended by her physician that she enter the hospital (Cohn 6). Despite the fact that Ms. Corcoran’s obstetrician’s recommendation was also approved by another physician, her HMO would not approve the hospitalization. Instead, it opted for home health care for ten hours each day (Cohn 6). Shortly thereafter, when the assigned nurse was off-duty, there were sudden complications, and the fetus died (Cohn 6). If this was not tragic enough, Ms. Corcoran was then informed that she could not file a suit for damages because of the 1974 Employment

Retirement Income Security Act, a federal health benefit regulation which prohibits the filing of pain and suffering lawsuits (Cohn 6). Do HMO members have adequate rights? Unfortunately, in 1998 the House of Representatives rejected a bill that would allow patients or their estates to sue HMOs and other insurers for denial of treatment. But there is much controversy over this issue and several pending bills. Presently consumers lack adequate rights in three areas: consumer information; access and quality; and appeal/grievance rights. Except for emergencies, all care must be authorized by a primary care physician, limiting access to specialists. In fact, when attempting to get a referral says Dr. Stephen Cohen (Founder of Physicians Who Care, MSNBC internet 1999) ?When the person

on the other end of the phone line doesn?t even know how to pronounce the name of the disease, it?s ridiculous.?. If a referral is granted, according to the HMOs guidelines, the choice of doctors is usually limited and those contracted by the HMO may not have the expertise to treat the medical problem. Grievances must be handled by an appeal to the HMO, the same entity which denied care in the first place. Moreover, the grievance process can take months or longer, in some cases resulting in serious harm to the enrollee. There are no statutes in place to allow for malpractice cases against HMOs, enrollees are usually forced into a binding arbitration case. Under federal law, workers enrolled in employer-sponsored health plans can sue their HMO to recover the cost of treatment that

was wrongly denied, but they cannot go to court to seek compensation for pain and suffering and to seek punitive damages. (Dallke) Patients are not the only losers in the web of the HMO scheme. Physicians are also becoming victimized by HMOs as are their patients. But in this case, it is financial rather than physical. Like HMOs, physicians are paid a fixed amount for each patient, and this figure does not vary. In other words, if the patient doesn’t show up for treatment, the amount is not adjusted. What this means is that if there are any savings, the physician benefits. However, when there are not, which is most often the case, the physician, not the HMO, assumes the liability. Simply stated, “The patient is costing the physician money the minute she walks in the door”

(Evans). ?Managed care replaces Hippocratic ethic with veterinary ethic. The owner paying the bill, the HMO, makes the decision. If they decide ?Fifi? isn?t worth the cost, the needed care is not given. Managed care is perverse. It destroys patient choice. It leaves the ethics of our profession in ruins.? (Jane Orient, MD). Dr. Linda Peeno testified before the U.S. House of Representative Committee on Commerce on May 30, 1996. She began her testimony. ?In the spring of 1987, as a physician, I caused the death of a man. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was rewarded for this. It brought me an improved reputation in my job,

and contributed to my advancement afterwards. Not only did I demonstrate I could indeed do what was expected of me, I exemplified the ?good? company doctor. I saved a half million dollars. The man died because I denied him a necessary operation to save his heart. I felt little pain or remorse at the time. The man?s faceless distance soothed my conscience. Like a skilled soldier, I was trained for this moment. When any moral qualms arose, I was to remember: I am not denying care, I am only denying payment. At the time, this helped avoid any sense of responsibility for my decision.? As a medical director, Dr Peeno?s priority was to protect the interests of the business, not the patients. There is no code of ethics for the ?company doctor?. The physician code of ethics addresses