In back-to-back announcements last week, PacifiCare Health Systems Inc. and Kaiser Permanente became the first managed care groups in the state to introduce point-of-service plans specifically for Medicare patients.
Shifting the elderly from fee-for-service care into managed care programs is one of the linchpins of President Clinton's efforts to overhaul and prevent the collapse of Medicare. But industry analysts say many seniors are reluctant to enroll in HMOs out of fear of losing access to favorite physicians or personalized service available under indemnity coverage.
Point-of-service plans are seen within the industry as more marketable to the elderly, as such plans offer greater choice of doctors and services than standard HMO plans.
PacifiCare's offering to Medicare recipients, called Secure Horizons Choice, charges a $45 monthly premium, for which members get to see any physician in or outside the PacifiCare network. But Secure Horizons Choice enrollees must pay or co-pay for many benefits delivered either by a physician or health care facility outside the network.
Kaiser's entry into the Medicare market, which still awaits federal approval, similarly lets members see any physician in or outside the network, and its premium is also $45 per month.
There are 3.8 million Medicare beneficiaries in California, of which 37 percent are currently in managed care programs.
Expanding southward, non-profit health care system Adventist Health has agreed to affiliate with South Coast Medical Center, a non-profit hospital in Orange County.
Adventist Health currently includes Glendale Adventist Medical Center, Simi Valley Hospital and Health Care System and White Memorial Medical Center in Los Angeles.
The new affiliation will expand Adventist Health's reach, which now includes 18 hospitals with 2,900 beds in California, Hawaii, Oregon and Washington. In Southern California, the group has 4,000 employees, 1,100 physicians and 1,050 beds at its three existing hospitals. South Coast Medical Center will add to that another 600 employees, 400 physicians and 210 beds.
A study out of UCLA's Center for Health Policy Research found that 17 percent of California's youth 1.6 million residents aged 17 and under have no health insurance, with Latino youth twice as likely to be uninsured as children from other ethnic groups.
In Los Angeles County, the total uninsured figure is even higher, with 25 percent of children without health care coverage, the study found. That's nearly twice the national level 13 percent of children nationwide have no health insurance.
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