Ensuring that Patients Come Before Profits
As the Congress begins its new session, one of the top priorities is expected to be passage of a Patients' Bill of Rights. This legislation is aimed at protecting people from some of the abuses that have been associated with managed care operations. While there is general agreement that managed care has helped to reduce medical costs in recent years, there is also evidence of a troubling and growing trend of health insurance plans to move medical decisions out of the doctor's office and into an accountant's office.

Over the past decade, the number of Americans enrolled in a managed care plan has risen rapidly. In 1987, only 13 percent of people with employer-provided health insurance were in a managed care plan. Today, 161 million Americans -- almost 60 percent of the U.S. population -- are insured through managed care plans.

A Patients' Bill of Rights would provide basic protections for people enrolled in managed care plans. This legislation has wide support in both the House and Senate, and also is endorsed by more than 180 different organizations, including the American Medical Association and the American Nurses Association.

Basically, the Patients' Bill of Rights would ensure that patients with a serious illness are allowed access to a specialist without having to get the permission of an accountant who does not have medical training. The legislation would give patients the power to go to any emergency room during a medical emergency, when every minute is critical, without waiting for pre-approval by their health insurance company. The Patients' Bill of Rights would give women direct access to their obstetrician/gynecologist and also would allow them to designate that physician as their primary care doctor. Finally, the legislation would ensure that patients who are denied care by an insurance company can appeal the decision to an independent reviewer and receive expedited decisions that are binding on the managed care plan.

The protections included in this legislation are not radical ideas. In fact, many health plans already provide these guarantees. This legislation is aimed at those plans which choose to put profits before patients and interfere with decisions that should be made by a doctor and patient.

As more West Virginians enroll in managed care plans, they deserve basic guarantees of protection. The Patients' Bill of Rights is the best way to ensure that health care is based on a medical diagnosis, and not on a business bottom line.
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January 13, 1999