Speaking Out

Deficit in Provider Info

As a health care consumer deciding which health plan to choose, I have concluded that the information I really need to make a good decision is not available. The brochures are clear enough; the meetings are helpful. I can compare the features of each plan, but I would like to know more. My questions are the kind that Consumer Reports might ask:
  1. Can the plan doctors' referrals be overruled? How frequently does this occur?
  2. Are the doctors limited in the treatments they can recommend?
  3. Do primary care physicians treat illnesses that would be better referred to a specialist, either be cause of the plan's policies or because the physician wishes to avoid the hassle of making a re ferral? Are there financial rewards for not making referrals?
  4. How many referral decisions are appealed? What are the outcomes of the appeals?
  5. How do current subscribers evaluate the care they receive?
  6. What is the experience of subscribers who have chronic illnesses?

Like everyone else, I will make a decision based on the information the Benefits Office provides and on a vast amount of hearsay evidence garnered from friends and colleagues. It is not the Benefits Office's job to provide consumer information on the health plans or to recommend one choice over another. I have to be realistic about the incomplete information that I have for this decision and work to make more consumer information available in the future.

-- Margaret Rohdy, Head of Research, Training & Quality Management
Van Pelt-Dietrich Library Center


Volume 43 Number 34
May 13, 1997

Return to Almanac's homepage.

Return to index for this issue.