Oversight for Managed Care

Re “Attack the Profit Motive, Not Case-by-Case Horror,” by Suzanne Gordon and Timothy McCall, and “HMO Trend Demands Eagle-Eyed State Oversight,” by Jamie Court, Commentary, Jan. 15:

The HMO approach to medical care is akin to our voice-mail system; it is impersonal and often time-consuming, but does get the job done most of the time at less cost. Thus one cannot fault them too much for having done too good a job in paying their executives very generously and maximizing their stockholders’ investment return.

In fact, in HMO lingo, money spent on health care delivery is categorized as a medical “loss” instead of a contractual obligation. Thus, there is a great need for society to establish a policy to balance the juggling between profiteering and patient needs. Perhaps making each health insurance contract span a five-year period, with exit permitted only under extenuating circumstances, would allow the HMOs more room to manage each case with a view more attuned to long-term benefits. As it stands now, the most profitable approach would be delaying the utilization of costly treatments for as long as possible.

JOHN T. CHIU MD

Newport Beach

* It is time during this turbulent transition from totally unmanaged to managed care to address the problems with constructive recommendations. These would include working toward meaningful improvement in the communication process between physicians and their patients (including caretakers) as well as increasing provision for home health services where indicated.

To be sure, there are many problems with the current delivery system of “sick care.” However, there is no reason to believe that the former unrestricted level of overutilization (which became the “gold standard of care”) was better for the patient or for the overall health of our society.

GERALD GERSHTEN MD

Northridge