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]