News briefs

Report: HMOs do not restrict access to care

A study of 35,000 privately insured individuals by the Center for Studying Health Systems Change found that HMOs offer similar access to health care and services as other types of health plans.

The report states that there is no difference in hospital visits, emergency room use or numbers of surgeries between HMO and non-HMO plans. Despite these findings, however, only 58% of HMO patients say they are satisfied with their health care, compared to 63% of consumers enrolled in less restrictive health plans or indemnity plans. The study suggests that HMOs may be judged unfairly due to a few high-profile cases.

The study also noted, however, that major differences do exist between plans when it comes to specialists. HMOs provide more primary and preventive services at lower cost, the study concluded, but they also increase barriers to specialist care. Non-HMOs offer greater access to specialists, the study found, but they also charge higher out-of-pocket costs. HMO patients are also more likely to report facing administrative barriers.

IOM calls for stronger health care safety net

Rising numbers of uninsured patients, combined with changes in Medicaid policies and cutbacks in government subsidies, are placing extraordinary pressures on the nation's health care safety net, according to a report released March 30 by the Institute of Medicine (IOM).

The report, which is from the IOM's committee on the changing market, managed care and the future viability of safety net providers, calls for competitive grants to bolster the types of health care institutions that provide care to the nation's poor and uninsured. This population, which rose 20% between 1988 and 1998, is now estimated to be about 44 million.

The IOM report also recommends that the government create a new oversight body to monitor and assess the condition of the nation's safety net providers and to review the impact of federal and state policies on the system.

While Congress and the president would ultimately determine the size of such an initiative, the committee estimated that it would cost at least $2.5 billion over five years. Funding could come from the federal budget surplus, unspent funds from the federal-state children's health insurance program and other insurance expansion programs.

CDC campaign to target DES

The CDC will launch a campaign later this year to educate doctors and patients about health risks in people who have been exposed to diethylstilbestrol (DES).

An estimated 5 to 10 million people have been exposed to DES while pregnant or in utero. DES is a synthetic hormone that was used to prevent miscarriages between 1938 and 1971 before it was found to cause serious health risks for pregnant mothers and their unborn children. Exposure to the drug has been associated with health effects like high-risk pregnancies (ectopic pregnancies, miscarriages, premature birth and infertility), structural genital abnormalities (epididymal cysts) and increased risk of breast cancer and clear cell cancer.

During pilot studies, the CDC found that many doctors are not aware of the risks associated with exposure to DES. Research showed that only 11% to 20% of doctors routinely ask their patients about DES exposure and that many doctors believe DES-related problems are no longer a concern.

The CDC hopes that its DES national education campaign will educate physicians and patients about the importance of identifying and treating individuals who have been exposed. CDC officials say that screening is the most effective way to detect potential health risks in exposed individuals.