The public backlash against managed-care plans is tarnishing the entire healthcare industry. The latest evidence comes from focus group research sponsored by the American Hospital Association, which reveals that antagonism toward health plans is fueling adversarial feelings between patients and medical providers.
The bickering is also being heard on Capitol Hill, where the most contentious issue is whether health plan enrollees should have greater ability to sue over treatment decisions. The Democrats, backed by lawyers and physicians, say yes. Republicans, supported by hospitals and insurers, say no.
We agree that the GOP approach is more prudent on the basis that lawyers and legal logjams could cause more problems than they repair. But that puts the burden on health plans to come up with better ways to settle grievances. Obviously, mediation and arbitration programs should be enhanced so unbiased decisions are made in a timely fashion.
Appointing an independent party to represent health plan enrollees at no cost is another viable avenue for consumer protection. The Local Health Plans of California, an association of eight not-for-profit organizations, recommends that an ombudsman staff report to a legal aid society, county public health officer or a respected community agency. Moreover, the group encourages providers and managed-care employees to report cases of inadequate patient treatment but says the ombudsman should avoid issues involving labor negotiations and workplace spats.
Hospitals and health systems must confront the managed-care credibility problem. They can serve a useful purpose but should stick to specific and justifiable patient complaints. Participating in the ombudsman process certainly seems a better alternative than facing liability lawyers.