Making a Killing: HMOs and the Threat to Your Health

One of the most powerful indictments to date of the managed care industry, this scathing expos presents case histories of those who have lost their health or their lives because an HMO denied or delayed vital treatments, tests or surgery. Consumer activist Court, advocacy director of the Foundation for Taxpayer and Consumer Rights, and public policy consultant Smith zero in on the insidious incentive for HMOs to withhold medical care in order to increase profits, thanks to the current capitation system, which allocates a fixed lump-sum payment for every patient under a provider's care, regardless of how much treatment each needs. HMOs, as portrayed here, are institutions driven by shortsightedness, negligence and greed, in which clerks without medical licenses overrule treating physicians to make life-and-death decisions, accountants scale down medical procedures and determine patient discharge times, and taxpayers are cheated out of billions by distorted federal expense claims for reimbursement. The authors set forth an arsenal of sensible proposals for reforms that would level the playing field for patients. An appendix, ""HMO Patient Self-Defense Kit,"" offers practical pointers on how readers can negotiate with their HMOs to get the care they need. This lively probe is must reading for anyone concerned with the health of the U.S. medical system. (Dec.)