Your Right to Choose Is Your Right to Care

By | April 29, 2011

Don't give up your right to choose!

We in the Los Angeles metropolitan area are very lucky when it comes to healthcare. There are large numbers of providers, insurers and care organizations and the market is highly competitive. This generally means more choices and lower prices for consumers. I am a member of several Internet medical discussion groups so I hear stories from all over the country, indeed all over the world. In many areas competition is not so strong and choice, service and cost always suffer and choice is always the first thing to go. One of the most disturbing examples of this is the rapid emergence of EPOs (Exclusive Provider Organization) over the last 2 years.

When insurance companies introduced PPO (Preferred Provider Organization) products 20 years ago the idea was that by signing up doctors and promising increased patient traffic, the insurance companies would be able to negotiate discounts on fees and pass the savings on to the consumer. With the transition to EPOs the same list of doctors now becomes exclusive in terms of patient choice. In other words in exchange for giving up the right to choose a doctor who is not on the list, patients are offered a modest discount.

Why should this be so? It is because the insurance companies have been quietly putting pressure on physicians not to prescribe costly treatments even if they are superior. Physicians who continue to exceed treatment guidelines are simply dropped from the PPO and EPO lists. But why should you the consumer care? Isn’t cheaper always better? The problem is quality.

When does the substitution of one component of healthcare result in a socially positive cost savings and when does it lead to inferior care and increased patient suffering? This is a very difficult question for even physicians to answer, no less for patients. The saving grace, at least in the Los Angeles market has always been that if a patient was unhappy with the care he received, he could always switch providers or go out of network for a higher level of care. Not so with EPO products, because there are no out of network benefits. This has the effect of turning the highly competitive LA market into a rural backwater, where there is only one option for care. Take it or leave it!?


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