Perspective               

For-profit Vs Non-profit HMOs

Non-profit HMOs may provide better care than for-profit HMOs, according to a study in the July 13, 1999 edition of the Journal of the American Medical Association. In this study, non-profit HMOs scored better on all 14 commonly reported quality measures, which ranged from routine preventive care, such as childhood shots and mammograms, to care for patients with serious illnesses, such as eye exams for diabetics.

When choosing a health plan, remember - quality matters. And quality varies between Medicare plans, too. As each doctor is different, each plan is different, with its own unique strengths and weaknesses. But, because there is still so little information available about the care different HMOs deliver, nobody knows for sure which HMO gives better quality health care; at this moment, no one can say.

Congress, realizing that people should be able to make health care decisions based on quality, is beginning to require HCFA, the government agency that runs Medicare, to release some quality information about Medicare HMOs. This information is now available on HCFA’s national Medicare website (www.medicare.gov). Two types of information are there: one - consumer satisfaction ratings based on a survey called the Consumer Assessment of Health Plans (also known as CAHPS) and, two - some very limited clinical performance measures that compare how well health plans prevent and treat illness.

Putting this information on the Internet is a good first step, but the information is still far from complete. It does not help people figure out which HMO is best for them. And it does not compare care in Original Medicare with care in different Medicare HMOs.

For now, we know that many people on Medicare choose a health plan based on the premium costs alone. But a choice based solely on cost is not a smart choice. People on Medicare cannot be expected to make a choice without good information.

If you need help making a Medicare choice, call your State Health Insurance Assistance Program, or SHIP. The number is listed in the back of the Medicare & You booklet - you should receive a new one this fall. You can also get a copy by calling 1-800-MEDICARE. Or call your Senator or Congressperson. They should have staff who can help you.

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