HMOs Fail To Screen For Cancer, Major Diseases

12 million Californians are at a greater risk for cancer and other major diseases thanks to HMOs that fail to provide adequate preventive care, according to a Health Care Quality Report Card produced by the California Patient’s Advocate.

The report compared how often the plans, along with about 200 physician groups, met 31 clinical quality standards, such as immunizing infants and screening adults for cancer, in 2006.

It found that almost one-third of middle-aged women hadn’t had a mammogram to screen for breast cancer in the last two years, for example, and that almost half of plan members older than 50 hadn’t been tested for colorectal cancer.

“As standards of care, they pretty much should happen 100% of the time,” said Ted vonGlahn, director of consumer engagement for the Pacific Business Group on Health, which helped prepare the report. “When you look at the averages, it’s pretty sobering.”

Each health plan’s individual rating was determined by comparing its performance on the 31 care standards with national averages. The overall clinical quality rating was expressed on a scale of one to four stars. No health plan received four stars, or an “excellent” rating.

Health Net and Kaiser Permanente each received the highest score for overall clinical quality, notching three out of four stars, or a “good” rating.

The rest — Aetna Health, Blue Cross, Blue Shield, Cigna, PacifiCare and Western Health Advantage — were given two stars, for “fair.”

Patients can’t be complacent in this era of for-profit HMOs. Ask your doctor directly if there are preventive tests that you haven’t received, and don’t hesitate to do independent research or seek a second opinion.

HMOs not meeting national standards in basic areas, report says [L.A. Times]
2007 Heath Care Quality Report Card [State of California]
(Photo: maessive)

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  1. MickeyMoo says:

    Kaiser may have scored a 3star rating now – but my dad never got a colorectal screening from them after he turned 50. When he went in complaining of abdominal pain 8 years ago they told him it was diverticulitis and sent him home. 2 months later they took out most of his lower intestine. Minimal follow up. When he started coughing up blood, it took them 2 months of poking and prodding to tell him he had metastatic lung cancer. They refused to try any experimental medications (Tarceva) until it was too late. 2 days after he died they cancelled his coverage without bothering to check that my mom still had benefits on the plan. That took 3 months to work out being bounced back and forth between Kaiser and his union retirement benefits coordinator. They might be a lower cost option for young healthy people – but I will go to my grave convinced they are Satan incarnate.

  2. bohemian says:

    HMO’s are not the only plan that drags their feet about proactive treatment. Step therapy or outright refusing to cover certain drugs even with a doctor asking for a formulary over-ride is standard business with most health plans.
    Most don’t even cover easy and obvious preventative programs like nutrition/weight loss or smoking cessation. I suppose they figure with how often most people change jobs and therefore insurance plans they can just kick the problem down the road for some other health plan to pay for.
    Ironically the main thing that keeps my health issues in check (self paced physical therapy) isn’t covered so I pay it out of pocket even though it is doctor mandated.

    @Mickeymoo, I’m sorry for your loss. I know two friends that died from cancer in the last five years. Both didn’t get more advanced treatment or drugs in time due to insurance and hospital money issues.

  3. Lars says:

    (Begin sarcasm) But geeze, wouldn’t we be much worse off with “socialized” medicine? (End Sarcasm)

  4. MickeyMoo says:

    @bohemian:

    Thanks :-) I appreciate that. The experience made me re-think my stance on “rationed care” and frankly I’m still not sure how I feel about it.

  5. IRSistherootofallevil says:

    I like BlueCross. I’m on my mom’s federal government program, and they’ve been very good…maybe because if the government gets pissed and moves to, say, MetLife, they’ve just lost 30 million clients.

  6. MickeyMoo says:

    Oh and don’t even get me started on how Kaiser’s pharmacy FORCES patients to accept prescriptions in a higher dosage pill than prescribed by the Dr. and then use a pill splitter to cut it down to size! Have you ever watched an 82 year old with cataracts and arthritis try to split a 1/4″ wide pill into even halves? If you complain about it to the pharmacist – they tell you that’s what they have and if you want the correct prescribed dosage you can’t have the $10 schedule generic – you have to opt for the $85.00 “brand name” version. EVIL EVIL EVIL

  7. JustAGuy2 says:

    @MickeyMoo:

    Blame the pharma companies for this one. They’ve often launched products that are chemically identical, but in different dosages, because that’s still under patent.

  8. Boberto says:

    I’ll take the Federal Government’s incompetence over Corporate America’s indifference and corruption when it comes to Health Care.

  9. BigNutty says:

    The best thing that ever happened to me was the ability to get rid of my HMO and going the private route.

    These pill companies give so many free samples to the doc’s to get their business that at one time I never had to pay for my prescription. My doc just gave them to me for free.

    Kaiser was a joke when I had them. I feel bad for all the people who are stuck with HMO’s that obviously only care about profit.

    I have a serious condition that Kaiser could never seem to figure out (or never wanted me to know about). Thank goodness my private doc got me on the road to treatment before it was too late.

  10. JiminyChristmas says:

    @MickeyMoo: In practice, we already have rationed care. The rationing is based upon your ability to pay.

  11. JiminyChristmas says:

    ‘Managed care’ is in a death spiral. Their own practices have doomed them.

    In order for HMOs to find the payoff in preventive care they need some assurance they will recoup the investment. That would mean their policyholders stay healthy longer and get less acutely ill when they do get sick.

    What happens instead is people jump from plan to plan as they or their employers shop for the least egregious hike in premiums every time they have to renew their policy. Personally, I’ve had four different plans in the seven years I’ve been with my current employer.

    Ergo, even though HMOs are supposed to be all about preventive care most of them give it little more than lip service. They are gambling that if they cheap out on preventive care now, you’ll be with a different insurer when you become seriously ill.

  12. chartrule says:

    Thank gawd here in Canada we don’t have to deal with HMO’s

    Here in Ontario, Canada we have OHIP (Ontario Hospital Insurance Program) through the goverment

    I have relatives in the states from what they have said HMO’s sound pretty scarey

  13. DrGirlfriend says:

    Why do you think Kaiser is runnings ads urging people to lead healthy lifestyles? It’s not because they give a crap about you, it’s because they’d rather not have to even see you.

  14. Sir Winston Thriller says:

    Yes, well while CIGNA reminds me that since I’ve turned 50, I need a colonoscopy, they don’t pay for it. And I don’t have the Mad Money to pay for the exam suite ($1620), the doctor ($1728), and the anesthesiologist($603) at Fletcher Allen Medical Center.

    I am relieved to note that colorectal cancer is covered, after diagnosis.

  15. SoCalGNX says:

    If Kaiser was rated highly, we are doomed. Two former coworkers told me of their family members who were misdiagnosed. One had cancer, the other one died from some internal malady after being sent home from the ER. My experience with them was dismal. Besides other adventures, my foot developed a bad infection after minor surgery. Do you think they would try to get me in?

  16. Nemesis_Enforcer says:

    My wife almost had to have a blood transfusion as a child in the early 80’s :O.. EEK right around the time they discovered that AIDS was in the donated blood supply. She fell cut her chin open on a fire hydrant, went to Kaiser with her mom and had to wait for almost 4 hours in the ER while “more important” patients went in first. After bleeding thru 4 towels and passing out a Dr. walking by noticed her and had her brought in immediatly. She was about 10 min. from needing a transfussion. Her mom was all over the ER desk to have a Dr. see her but these untrained monkeys decided she wasn’t a priority cause it was just a cut. Everyone knows cuts on the neck and face bleed like a mofo. She needed 18 stitches to close it.

    Kaiser needs to burn in hell.

  17. Nemesis_Enforcer says:

    Oh I almost forgot I worked for Healthnet a few years ago and they don’t cover preventative medicene. You have to exhibit a symptom or have a family history to get preventative screenings. So if your Dr. is smart they will describe a symptom needed in order for you to get a preventative screening.

  18. Beerad says:

    @IRSistherootofallevil: For soemone who apparently hates federal taxation, you seem to have no problem with the government spending lots of tax dollars on employee benefits with dependent care, eh?

  19. MickeyMoo says:

    @JustAGuy2: My understanding is that pharmaceutical companies charge the same wholesale rate for medications regardless of strength (ie: my mom’s pills would cost Kaiser the same amount whether she’s consuming a 50mg or 100mg pill) But by forcing her to split a 100mg pill into 2 parts – they (Kaiser) are saving 50% on the cost of her meds. While I agree with you that “BigPharma” is a huge problem – this specific issue has a lot more to do with Kaiser than anyone else.