American College of Physicians: Internal Medicine — Doctors for Adults ®


Advancing the patient protection debate

From the January 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

When Congress reconvenes this year, it is likely to take up an issue that was left unresolved this fall: how to protect the rights of patients in health insurance plans. And any new debate is likely to hinge on the sticky question of whether and how much new patient protections might raise the cost of health care.

Two new studies released by the Henry J. Kaiser Family Foundation attempt to shed light on the question of exactly how much it costs to enact patient protection legislation. They conclude that some regulation, such as external review of health plan denials by states, may not raise costs significantly. Researchers also found that many medium and large employers already require their health plans to provide some of the protections being debated in Congress, which means that requiring these protections won't necessarily increase health insurance premiums as much as some had worried.

Researchers also found that external review programs, which are used by 18 states and Medicare, lead to very few disputes between patients and health plans. (The range was 0.04 cases per 1,000 enrollees in Pennsylvania to two cases per 1,000 managed care enrollees per year in Medicare). Across all programs studied, the researchers found that external review overturned health plan decisions 32% to 68% of the time. They also found that total costs of the programs were small, with costs per case usually less than $500.

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