- Look for a 15- to 20-year history.
- Don’t go with a for-profit HMO and doctors with financial risk.
- Demand a fully accredited plan and reporting on FACCT measures.
- Don’t agree to high heart bypass and angioplasty rates.
- Require high cervical and breast cancer screening rates.
- Don’t accept a high proportion of C-sections.
- Seek high diabetic retinal testing rates.
- Don’t skimp on mental illness.
- Find a plan with available doctors.
- Don’t join a plan with unhappy doctors.
- Look for highly satisfied members.
A for-profit HMO is dramatically different from a not-for-profit plan. While both have an incentive to keep costs down, the not-for-profits in this country tend to be far more focused on members’ well-being.
C-sections involve anesthesia, major surgery and longer recovery periods with more complications than normal deliveries. Look for a C-section rate of 15 percent or less of all childbirths. The national average is 20.7 percent.
The best HMOs will have a high percentage of members who deem themselves "completely satisfied," and a low percentage of those who are dissatisfied. Shoot for a better-than-average rate of 65 percent to 75 percent for the combined categories of "completely" and "very" satisfied.
SOURCE: Excerpted from "Choosing and Using an HMO." Copyright 1998 by Ellyn Spragins. Published by arrangement with Bloomberg Press. Available at better bookstores and through Amazon.com. May not be modified, copied, reproduced, uploaded, posted, transmitted, or distributed in any manner.