Laws Won't Let HMO's Tell Doctors What to
Robert Pear, in a new York Times article of September 17 1996, reports
as a sign of growing concern about the practices of some health maintenance
organizations, 16 states have adopted laws this year to nullify efforts
HMOs to limit what doctors can tell their patients.
Doctors have complained that some HMOs forbid them to discuss costly
treatment options or financial incentives for doctors to withhold care.
The extent of such restrictions, or gag clauses, is in dispute, but some
contracts clearly impose them. HMOs say they favor open communication with
patients on medical questions but should be able to withhold confidential
business information and the details of contracts with doctors.
The swift bipartisan response by state legislators demonstrates the
volatile climate in which HMOs and insurance companies now operate. The
limits on what doctors can say did not even materialize as a public issue
until last December. Now Congress is considering a measure to prevent HMOs
from restricting doctor-patient communications, and President Clinton
recently endorsed it.
Health maintenance organizations have evidence showing that they can hold
down health costs while maintaining a high quality of care. Enrollments
soaring, with more than 60 million Americans in HMOs and perhaps 90 million
in other managed-care plans. But some of their practices have generated
surprising hostility in state legislatures.
The state laws vary. At a minimum, they protect the right of doctors and
patients to discuss all treatment options.New York provides a broad range
of consumer protections, guaranteeing the doctors' right to discuss any
"course of treatment" and requiring health plans to disclose
in general terms how they pay doctors.
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