Many are still willing to pay more for health care choice and access. Good luck selling them on socialized, choice-rationed medical care:
In particular, HMOs have lost ground to a kissing cousin, the preferred provider organization, or PPO.The least restrictive of managed-care plans, PPOs allow health plan members to go outside of an insurer’s list of doctors and services, but at a greater cost to the consumer. A typical PPO might cover 80 percent of a surgery at an in-network hospital but only 60 percent at a facility not on the insurer’s list.
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{ 6 comments }
We’ve just made the switch, effective 12/1.
Once upon a time, I had an HMO, and I chose to go outside of them for my wisdom teeth removal even though I had the same doctor with or without the HMO (I went to his private practice instead of to the HMO clinic). The reason? The HMO clinic was amazingly poorly run, to the point where all of the back and forth and running around I had to do with them made me cry. In addition, they were requiring all sorts of additional proceedures completely unnecessary to the removal of my wisdom teeth. Given how the clinic was run, I don’t understand how HMO’s save money, except by convincing people that getting necessary proceedures isn’t worth the hassle of dealing with them. All in all, it was the worst medical experience of my life, and I spent over a year in Ecuador where I had frequent contact with their medical system.
This proves nothing about patient preference. Companies don’t consult their employees about what health care insurance options will be offered. Two years ago I had an HMO and was fine with it. Last year our coverage changed to only one option, a PPO. It’s fine, and I’m frankly just thrilled to have health insurance in this day and age, but it wasn’t a personal choice.
I switched from an HMO to a PPO a couple of years ago. My company stopped offering the HMO I used. That HMO had a wide network that included virtually every medical group in the area and had some out-of-network coverage. The only HMOs that were left had no out-of-network coverage and fewer participating doctors. The cost was the main reason my company stopped offering HMOs with wide networks; so I guess HMOs aren’t that cheap.
Having a choice to find a really good specialist in case it ever becomes necessary is important to me. But even without it, just not having to get referrals is convenient as it saves time.
20% in-network/30% out-of-network is certainly higher than what I used to pay, but it is well worth the choice.
Our employer offers HMO and PPO. We pay more than double the premium for PPO and we’re grateful to have the choice. Much larger pool of primary care physicians, much easier to get referrals & procedures approved. Better overall benefits including lots of off label stuff like chiro, accupuncture, massage, discounts for health clubs, OTC products like vitamins, etc. Lots of local doctors don’t even accept HMO patients anymore.
Perhaps another reason is that a lot of physicians have opted out of participating in HMO’s. As long as my schedule is full without having to deal with an HMO, why should I bother with them? A single payor system would be an entirely different story. Most physicians would participate out of economic necessity – like Medicare. Lack of choice would not be an issue.
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