Your Health Insurance –- How Dangerous?

By Michael Brennan

These warnings about health insurance come from three informed sources:

1. seriously ill people with health insurance plans, surveyed by Consumer Reports,

2. doctors affiliated with HMOs serving Illinois,

3. the National Committee for Quality Assurance.

1. 25 to 37 percent of HMO members who were seriously ill “said they had

trouble getting care,” according to a Consumer Reports survey.^¹

2. At least 23 percent of doctors scored each of 12 Illinois HMOs as less than “good” on ability of patients to

see appropriate specialists
get needed tests and treatments
get appropriate drugs.^²

3. Dangerous quality gaps persist in health plans.

The National Committee for Quality Assurance wrote, “… enormous differences persist between the performance of the health care system as a whole and the top 10 percent of health plans who report on quality.

“These ‘quality gaps’ represent the continuing failure to consistently deliver care in accordance with well-established guidelines and exact a substantial toll in terms of both lives and economic costs.

“If the entire health care system performed at the level of the top accountable plans, between 37,600 and 81,000 deaths would be avoided per year ….”

“Low-quality care leads to an estimated 64.7 million avoidable sick days: the equivalent of almost 270,000 full-time employees, or the combined workforces of Starbucks and Boeing, calling in sick for an entire year.”^³

1 Over 12,000 HMO members and 23,000 PPO members answered a Consumer Reports questionnaire. “Among those who had a serious illness, satisfaction varied widely between those enrolled in the top third and bottom third of the plans. In the top-rated HMOs, for example, 25 percent said they had trouble getting care. In the low-rated group, the share [of the seriously ill] complaining jumped to 37 percent.” www.consumerreports.org. HMO vs. PPO Ratings: September 2005.

2 “HMOs,” Chicago Consumers’ Checkbook, Spring/Summer 2007, Pages 105-108. Most HMOs were rated by 136-165 doctors affiliated with them within the last two years.

3 National Committee for Quality Assurance, “The State of Health Care Quality, 2006,” Executive Summary. Emphasis added. www.ncqa.org.

And some 18,000 Americans ages 25-64 die yearly for lack of any health insurance, according to the Committee on the Consequences of Uninsurance, Board on Health Care Services, Institute of Medicine, Care without Coverage: Too Little, Too Late (Washington, D. C.: National Academy Press, 2002), Page 162. Some 840 of these 18,000 uninsured dying are estimated to be in Illinois. Later estimates of the numbers of Americans and Illinoisans dying for lack of health insurance are higher.