UNC-CH Study Shows State Protects HMO Clie...( CHAPEL HILL N.C. -- North Carolina fa...),Health

CHAPEL HILL, N.C. -- North Carolina fails to protect the interests of state residents enrolled in health maintenance organizations nearly as well as it should, chiefly because the organizations have grown so fast that laws and regulations have not kept up, according to a new University of North Carolina at Chapel Hill study.

The study, conducted UNC-CH's Cecil G. Sheps Center for Health Services Research in association with the N.C. Institute of Medicine, included an HMO “report card” sprinkled with 13 letter grades ranging from two “A”s to two “D-minuses.” Overall, North Carolina's HMO consumer protection received a “C-minus” when compared with other states and industry standards.

“North Carolina has experienced an explosion in the growth of HMOs and managed-care companies,” said Pam C. Silberman, a lawyer who is research associate at the Sheps Center and a member of the institute. “Between June 1994 and November 1996, the number of licensed full-service HMOs skyrocketed from 10 to 23, with several HMO license applications pending review.”

HMO enrollment here grew steadily in the early 1990s, with annual increases of between 50,000 and 100,000 people, Silberman said. By the end of 1996, 954,967 people were enrolled in full-service HMOs or point-of-service plans across the state.

“In general, we found that the North Carolina Department of Insurance does a relatively good job enforcing current state HMO laws,” she said. “However, North Carolina lacks an adequate array of laws to ensure that consumers are fully protected.”

Silberman directed the study of state oversight of HMOs in partnership with Dr. Thomas C. Ricketts, deputy director for health policy analysis at the center. The researchers closely analyzed laws governing HMOs in North Carolina and looked specifically at the state's si
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Contact: David Williamson
rdtokids@email.unc.edu
919-962-2091
University of North Carolina at Chapel Hill
29-Apr-1997