Health Access - Defending and Expanding the HMO Patient Bill of Rights

Home Providing Consumer Protection Support Additional HMO Consumer Protection Defending and Expanding the HMO Patient Bill of Rights

Implement the Patient Bill of Rights & Close any Remaining Loopholes

Managed health care was developed and became the predominate health insurance coverage in California in the 1980's, promising to control health care costs. Today more than 90% of Californians with health insurance provided by their employer are in some form of managed care. Unfortunately, the efforts to reduce costs initiated by the HMOs (Health Maintenance Organizations) were not balanced with any controls to ensure that decisions to limit access to essential medical services would be made keeping the medical needs of consumers foremost in consideration, and not just the bottom line of health insurance companies. Over the course of the last decade, the scope and severity of problems with managed health care became increasingly evident to consumers, consumer advocates, the media and policymakers.

A national survey conducted in 1997 by the Harvard University School of Public Health and The Henry J. Kaiser Family Foundation demonstrated that Americans perceive a decline in both the quantity and quality of health care services under managed care. Those surveyed reported that managed health care plans have: Decreased the amount of time doctors spend with patients (61%); Made it harder for the sick to see medical specialists (59%), and; Decreased the quality of health care for the sick (51%) (The Henry J. Kaiser Family Foundation, Kaiser/Harvard National Survey of Americans' Views on managed Care, November 5, 1997).

Consumers have been confronting the following problems: lack of information about health plan policies and procedures, including standards for denying medical treatment; denial of access to health care specialists; failure to cover treatment for a range of conditions including severe mental illness.

Health Access and other consumer advocates lead a five-year effort designed to pass a comprehensive Patient Bill of Rights (PBOR) to redress some of the problems described above with managed care plans in California. While much of the proposed legislation passed the California legislature over the last several years, most of these were vetoed by then Governor Pete Wilson. Finally, in 1999, the California legislature passed, and Governor Gray Davis signed, landmark legislation affecting 23 million Californians who receive health care from managed care plans.

Important future work remains to assure the effective implementation of the PBOR, including the start-up of the newly established Department of Managed Care (DMC) and close the remaining loopholes which the HMO's are busy creating to avoid implementation of the PBOR.