Physician lists his HMO concerns

Healthcare in the United States has dramatically changed since the advent of the health maintenance organization.

Initially, HMOs were designed to provide lower-cost healthcare for individuals who otherwise could not afford healthcare. But, as with many good ideas, the actual practice has changed and the emphasis has shifted from healthcare to the business of making money.

HMOs are large business organizations. They buy and sell contracts for healthcare from the major healthcare providers. Health- insurance policies are bundled and traded as commodities. People are collected, traded and sold as “patient lives.” Your local HMO gets paid a fixed amount per head per month. It is on a fixed budget. If a physician provides “cost-effective” healthcare, the profit is then given back to the physicians and administrators as a “bonus,” rather than a kickback. This is called a “Shared Risk Program.”

So, what can you do as a patient to insure the best healthcare for you and your family? First, look for the warning signs that your physician or HMO is more interested in his or her “Shared Risk Distributions” than your health.

The warning signs are as follow:

— Avoid physicians who make you wait for hours. These physicians are rushed and stressed.

— Do not put up with the five-minute visit. Your doctor cannot make rational decisions or listen to your problems in such a short time.

— Avoid HMOs that stubbornly refuse a referral to a specialist.

— Stay away from doctors who write prescriptions at the drop of a hat and will not spend time to discuss holistic, nonmedical, therapy and risk-factors modifications.

— Most of all, avoid physicians who perform multiple tests and never give you the results.

If the above occurs, find another doctor and insurance policy. Easier said than done! The large healthcare providers are a monopoly. They do not provide real choices. Alternatives to HMOs are usually priced so high, they are out of reach for most.

Fortunately, here in Ventura County, there are real options. Check for a Point of Service or Preferred Provider plans. These plans allow you to pick your doctor, they do not advocate a shared distribution for reduced medical care, and they allow your physician to obtain the necessary referrals and testing imperative to your health. The 30-year experiment with HMOs has been helpful. It shows that when large businesses are involved in healthcare, their ultimate goal is to take your healthcare dollars and put them into their pockets.

— Michael Jamison, M.D., of Camarillo, is a cardiologist and internist with a private medical practice in Oxnard.
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