Copyright 2000 / Los Angeles Times
Los Angeles
Times
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November 19, 2000, Sunday, Home Edition
SECTION: Business; Part C; Page 5; Financial Desk
LENGTH: 286 words
HEADLINE:
MANAGED-CARE REFORM
BODY:
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"Ailing Doctor Groups in Critical Need of Remedy" Nov. 5 was fairly
comprehensive in its analysis but failed to mention several key components of
the problems facing California's medical groups.
Capitation rates by
commercial HMOs to medical groups for commercial patients in California are
roughly half the rates found in the rest of the nation, and are only slightly
higher than those paid by Medi-Cal HMOs for their managed-care patients. Is this
reimbursement really what employers and their employees want for their care?
Could this possibly be the main reason roughly 90% of California medical groups
are in dire financial straits (according to California Medical Assn. estimates)?
Perhaps the biggest obstacle to managed-care reform is
the lack of understanding patients have of managed care. Most of my patients,
with whom I routinely answer all questions (both medical and bureaucratic in
nature), have no concept of capitation whatsoever. Furthermore, most patients do
not comprehend the difference between their health plan and their medical group,
and they have no idea that the former subcontracts to the latter for their
health care.
California's health plans are currently torn between
satisfying their investors and supporting the medical groups that actually
perform the care they claim to provide.
KENNETH S. ALPERN, MD
Chief of Dermatology
KPC Medical Group
Los Angeles
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LOAD-DATE: November 19, 2000 
