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.
“These kids do not have regular access to preventive health care, such as immunizations, and have too few options for care when they are sick,” said Richard Brown, the report’s author and director of the UCLA center. As a result, Brown said, children wind up receiving costly emergency treatment for ailments that could be headed off with early treatment.
“When these kids have an earache in the middle of the night, their parents don’t have any option other than to take them to the hospital emergency room,” he said.
The study found that Latino youth in California are the least likely to have health insurance, with 29 percent uninsured, compared to 12 percent of Asian American youths and 10 percent of both white and African American children in the state. The trend carried over even to Latino children whose parents are employed full-time.
Ironically, the study found that uninsured children are as healthy overall as children with insurance, and healthier than children who receive Medi-Cal coverage for the very poor.
In a related study, UCLA and Rand Corp. researchers found that children of working Latino families are vastly underserved by Medi-Cal. The study found that, among Medi-Cal-eligible Latino children aged 3 and under in East and South Central Los Angeles, 40 percent are getting inadequate health care.
UCLA pediatrician Neal Halfon, who headed the study, said the Medi-Cal system has failed to reach local patients beyond the single-parent, unemployed sector who receive Aid to Families With Dependent Children. The Latino working poor in low-wage jobs with no health insurance have fallen through the cracks, Halfon said.
Sixty percent of U.S. hospitals and other health care facilities reduced their work force over the last two years, according to a survey by Los Angeles-based Smyth, Fuchs & Co. human resources consultancy. On average, 7 percent of employees at the 250 hospitals surveyed had lost their jobs, the survey found. In addition, 37 percent of the facilities were involved in at least one merger or acquisition during the two-year period.
“The growth in managed care, a shift from inpatient care to outpatient care, and emerging technologies” have been the driving forces behind the downsizing, according to Glen Smyth, president of Smyth, Fuchs.
Sylmar-based MiniMed Inc., which markets an implantable insulin infusion pump for diabetics, said it is expanding its product line with a new glucose management system. The system is meant for hospital use and will let physicians monitor and adjust the blood sugar level of patients. MiniMed is teaming up with Boehringer Mannheim Corp. of Indianapolis, the largest maker of glucose meters worldwide. Under the alliance, MiniMed will make the new management system, while Boehringer Mannheim will market and sell the device
Oclassen Pharmaceuticals Inc., a wholly owned subsidiary of Watson Pharmaceuticals Inc. of Corona received U.S. Food and Drug Administration approval last week to market a gel to treat genital warts. Condylox Gel will replace the company’s previous product for such treatment, Condylox Topical Solution. The topical solution generated $10 million in sales last year.
Oclassen develops and acquires proprietary dermatological products. The prescription dermatology market in the United States garnered an estimated $2 billion in sales last year.