NBCH Policy Papers
Spring, 2000
Position on the Patients' Bill of Rights
The National Business Coalition on Health (NBCH) opposes legislation to mandate the Patients' Bill of Rights (PBOR) and opposes expanding patients' capabilities to sue health plans and employers in state and federal courts. NBCH is committed to "community health reform" by improving the value (cost plus quality) of health care provided through employer-sponsored health plans. NBCH understands the motivation behind the PBOR currently pending in the House-Senate Conference Committee. However, we believe that health care reform should build on the demonstrated strengths of the private market place with government intervention limited to the promotion of open competition. Legislation mandating what health plans must offer to consumers and subjecting plans and employers to increased liability, particularly in state courts, affects the cost of doing business.
Health care is the second largest cost for employers, behind salaries. Based on a December 1999 report released by William M. Mercer, Inc., this year employers can expect health care costs to rise 7.3 percent. Small businesses are confronting even higher increases of 20 to 30 percent. These statistics do not reflect the additional cost of the PBOR legislation. A recent Congressional Budget Office (CBO) scoring of the House version of the PBOR indicates that the bill would increase health care premiums by an additional 4.1 percent annually. Legislation that mandates certain coverage and demands added liability for plans and employers could push these increases even higher, without resulting in improved care. According to a recent survey conducted by Hewitt Associates, 36 percent of the 600 large U.S. employers surveyed responded that they would probably drop health benefit for their workers if they were subject to health care insurance malpractice suits.
Added legal liability likely would force many employers to scale back or even eliminate health care benefits for their employees and retirees. Consequently, consumers quickly would be confronted with higher health care costs as well as the responsibility of finding coverage, a burden for which many employees are not prepared nor willing to assume. Employment-based health plans have strong public support and have proven to be effective because they offer many advantages over other forms of health insurance and types of delivery systems. The advantages include reduced risk of adverse selection, group-purchasing efficiencies, employers acting as a workers' advocate, delivery innovation, and health care quality.
As an alternative to more lawsuits, NBCH supports an improved internal and external appeals process and believes these procedures should be given an opportunity to work. They have the potential to be a faster, more logical and cost-effective means to resolve justifiable consumer issues. Many health plans and employers are making significant changes to their own practices, including allowing coverage decisions to be reviewed by independent medical experts when beneficiaries are dissatisfied with their plan's action on their claim. Again, these reforms should be given a chance to show results before concluding that lawsuits are the only solution.
A half-century of lawsuits against providers has not made medicine as safe, efficient and effective as it can and should be. Over-utilization, underutilization and inappropriate care continue despite the type of provider or health plan. In November 1999, the National Academy of Science's Institute of Medicine (IOM) issued an independent report, based on expert studies, indicating that up to 98,000 people die in any given year from medical errors that occur in hospitals. NBCH has a mission to build relationships of trust with health care deliverers because it ultimately is in their hands to make the system work. However, we need better measurement systems, particularly those based on physicians' clinical information, to verify that we are getting the best results in the most efficient and effective manner.
Growing numbers of employers are harnessing market forces to drive improvements in the delivery of health care by setting quality standards and measuring health plan and provider performance. Employers and their local coalitions are helping develop, test, and promote quality measurement using a variety of methods. These include:
- A standardized "request for information" (RFI) for selecting health plans based on various national, regional and local information;
- "CAHPS" consumer satisfaction survey sponsored by the Agency for Health Care Research and Quality (AHRQ);
- Patient-oriented quality measures endorsed by The Foundation for Accountability (FACCT); and
- National Committee for Quality Assurance's HEDIS measures.
These tools enable purchasers to forge an accountable health care system, using market-based principles to improve health care quality more effectively than legislative mandates or government regulations.
We encourage government and other public sector purchasers to join us in our mission of value-based health care purchasing.
The National Business Coalition on Health (NBCH) "the coalition of coalitions" has a membership of nearly ninety employer-led coalitions across the United States, representing over 8,000 employers, predominately medium and large-sized private sector employers, and approximately 28 million employees and their dependents.
|