Privacy Regs, Clinical Trials, HMO Care, Alternative Medicine, Malpractice Insurance
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Doctors believe that health plans and government agencies already ask for information that violates patient confidentiality, according to a poll by the Association of American Physicians and Surgeons. And most respondents expect the new privacy regulationsscheduled for full implementation in 2003to exacerbate the problem.
Nearly nine out of 10 doctors report that patients have asked them to omit certain information from their medical records. And physicians are bending the rules to accommodate them, says Kathryn Serkes, AAPS public affairs counsel.
The PHICO Insurance Company is on the brink of financial disaster, with its surplus shrinking from more than $127 million at the end of last year to $6.7 million. Control of the Pennsylvania-based underwriter has been turned over to the state, which will oversee the company's finances as well as the development of a payment plan that will safeguard policyholders.
Policies are still in effect, and claims are being paid. If PHICO becomes insolvent, guaranty funds across the country would be tapped to pay claims and refund unearned premiums. The company is licensed to write coverage in all 50 states.
There's bad news, too, for policyholders of The St. Paul Companies. Losses have prompted the Minnesota-based insurer to seek steep rate hikes for physicians, who can expect premiums to increase by 10 to 65 percent at renewal.
Recognizing that publication of research findings in peer-reviewed journals is the ultimate basis for most treatment decisions, the editors of top medical journals in the US and six other countries have toughened their requirements for submitting manuscripts.
In the past, the editors noted, "corporate sponsors have been able to dictate the terms of participation in the trial, terms not always in the best interests of academic investigators, the study participants, or the advancement of science in general.'' To avoid potential conflicts of interest, the journals will now ask authors to sign a statement indicating they had full responsibility for the conduct of the trial, had access to the data, and controlled the decision to publish.
HMOs have markedly improved their clinical performance in each of the last two years, according to the National Committee for Quality Assurance. Indeed, among the 273 health plans that allowed their data to be released, every clinical measure tracked improved last yearin some cases, by more than five percentage points.
Despite HMOs' severe financial problems and declining enrollment, NCQA says health-plan patients are more satisfied these daysat least with their own physicians. Though some patients still complain of being shortchanged on time spent with their doctors, they're generally more pleased with their physicians than with the HMO's overall performance.
|Percent of patients responding*|
|Patients say doctors ...||Always||Usually||Sometimes||Never|
|Explain things clearly||64||30||6||1|
|Respect their opinions||62||30||7||1|
|Spend enough time with them||49||36||12||3|
When it comes to some chronic, debilitating conditionssuch as headaches and neck and back problemspatients believe they have more success with complementary and alternative medicine (CAM) therapies than with traditional approaches, according to a recent study.
Nevertheless, seven out of 10 who seek treatment from CAM providers generally see their medical doctors first or at the same time. That's because four out of five patients believe that using CAM therapies in conjunction with traditional medicine is far superior than either discipline alone.
The majority of patients are reluctant to tell their medical doctors that they're seeking alternative treatment. The study appears in the Sept. 4 issue of the Annals of Internal Medicine.
Joan Rose. Practice Beat. Medical Economics 2001;20:12.