Quality of care

Though it is a single study, the results of research at Tufts’ New England Medical Center are a disturbing look at health maintenance organizations and what must not become a part of the country’s future. Congressional and federal health care officials should use the study as inspiration to ensure that the quality of health care does not continue to bow to costs.

The researchers, reported last week in the Journal of the American Medical Association, found that, “Patients who were elderly and poor were more than twice as likely to decline in health in an H.M.O.,” compared with fee-for-service plans. More than 60 million Americans belong to HMOs, which continue to grow rapidly nationwide and are expanding in Maine.

The results of the study should be of particular concern to the state’s Department of Human Services, which is seeking HMOs to care for Maine Medicaid patients. The move is designed to save money, which could eventually lead to more people being covered, but must be made with an eye toward maintaining the quality of care. The research ought to prompt Maine and other states to begin to more closely examine the delivery of services among competing HMOs.

According to the authors of the study, led by John E. Ware Jr., chronically ill elderly patients who are poor “account for a disproportionate share of health care expenditures and are therefore prime targets of cost containment.” Though HMO’s claim to have improved services since the study began in 1986, pressure to contain costs is likely to increase in coming years, which may mean that a lower level of care will spread to people in categories that approach the expenditures in the group studied.

What is disturbing about the study is its conclusion that patients who are most sick and least likely to be able to afford to obtain care on their own have found their care so significantly diminished. No one doubted that HMOs could less expensively care for young, healthy clients. The nation also needs a system to care for those for whom preventive medicine no longer is a realistic option.

If the cost of health care was the primary concern in the first half of this decade, the quality of care will be in the second. This study on the elderly poor is a warning to officials to prepare to revisit health care reform soon.