California Individual And Group Health Insurance Plans

The San Diego Union-Tribune - Sep. 20: When it comes to satisfying patients, doctors in San Diego and two other California cities fall short when compared to their counterparts in other major U.S. metropolitan areas, according to a new survey.San Diego County ranked 16th among the nation's 20 largest urban areas when patients here were asked if they trust their doctors, and it placed 17th when they were asked if their doctor understands their condition. Los Angeles and San Francisco ranked 17th and 20th, respectively, in the trust question, and 12th and 16th concerning whether physicians understand patient problems.The survey, which was not scientific, was done by HealthGrades, a Golden, Colo., company that rates hospitals and provides information about physicians.The survey questioned 41,148 people who visited HealthGrades' Web site and who had seen a doctor at least twice in the previous year. Surveys were collected from 702 patients in San Diego County, said HealthGrades spokesman Scott Shapiro.The results didn't surprise Dr. Theodore Mazer, president of the San Diego County Medical Society, who said administrative and financial pressures cut into the time and resources that doctors can devote to each patient.With health management organizations dominating California's health insurance market, physicians spend much of their time filling out paperwork and seeking permission from HMOs for patient tests and referrals, Mazer said. "In most areas of the country, you don't have to stop everything and call a plan to say 'Mother may I,' " he said.San Diego ranked 12th when patients were asked if their doctor spent enough time with them and 14th when they were asked if they would recommend their physician to others.Houston and the Dallas-Fort Worth area scored at the top of the lists for each question in the survey.San Diego physicians also must contend with low reimbursements from Medicare and high operating costs that force them to see more patients in order to generate enough money to make their practices profitable, said Mazer, who schedules to see a new patient every 15 minutes during his normal workday.Doctors from San Diego have long complained about the federal government's method for determining how much to pay for physician services here; it lumps San Diego with rural counties where the cost of providing health care is cheaper. Making matters worse is the high cost of living in San Diego, they say.Christopher Ohman, president and chief executive officer of the California Association of Health Plans, brushed off any finger-pointing at members of his group. "It's so easy to blame HMOs for everything," he said.He noted that the degree of separation between the highest- and lowest-ranked metro areas in the survey was less than 10 percent on each question, suggesting a relatively narrow difference among the cities.Another factor in the survey could be that California patients are harder to please than patients in other states, said Dr. Lance Lang, vice president and senior medical director of HealthNet, a Woodland Hills HMO with about 150,000 beneficiaries in San Diego County. Californians tend to have "higher expectations" when it comes to medical treatment, he said.HealthNet has begun using so-called health coaches to teach patients to be more interactive with their doctors and more involved in decisions about care, Lang said. "They wind up having more faith (in their physician) when they are a partner in the decision rather than just responding to a decision made by a doctor," he said.