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What's Not to Like about HMOs

Journal Articles

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Health Affairs, Vol. 19, page(s): 206-209

July/August, 2000

HACvrNew

It's a girl! My doctor's long-awaited pronouncement heralded one of the most joyous moments of my life. More surprising for this first-time mother was the extent to which so many people shared in our enthusiasm. Not just family and friends but my employer, banker, the owner of the local Chinese restaurant, even the farmers at the local farmer's market. They sent gifts, cards, and messages to demonstrate their affection for the precious addition to our family. The notable exception in this celebration was my health maintenance organization (HMO). When an HMO representative called, it was to deny financial responsibility for my daughter's care.

I have devoted the past ten years of my career to working on ways to make a private, employer-based health care system work more effectively. I believe that HMOs can be part of the solution. From 1997 to 1998 I directed the staff work for the chair of the California Managed Health Care Improvement Task Force. The following year I led a study aimed at improving health coverage decision making in California. To learn that I had been denied health care services was personally disappointing and, considering my professional expertise, ironic. We all hear stories of coverage and claims denials, but when it happened to me, I understood the intense anger people feel about these episodes. My experience resulted in a clearer understanding of why HMOs are so widely disliked.

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