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The "Putting Patients First" Controversy

In November of 1995, the National Health Council (NHC) issued a declaration of patients' rights. The NHC is an organization for people with chronic diseases, or more precisely, it is a coalition of specific groups such as the American Cancer Society, the American Lung Association, the Arthritis Foundation, the Epilepsy Foundation of America, and so on.

Don L. Riggin, the Council's chairman, said, "We are concerned that potentially higher costs associated with treating the chronically ill patient may be at odds with managed care's emphasis on holding down expenses. We want to make sure that any potential conflicts are resolved in the interest of the patient". The document which the Council produced then was titled "Putting Patients First". Tens of thousands of copies have been distributed.

The American Association of Health Plans (AAHP) represents more than 1,000 HMOs, PPOs, UROs and other network based plans. They directly lobby at the federal level, they keep track of legislative action in all fifty states, and they "mobilize" employees and favorable patients of their member organizations for coordinated periodic visits to Congress. Worried that criticism of the practices of HMO's "were undermining public confidence in managed care and could harm their companies' financial well-being", the Association thought it had better have a public relations campaign of its own.

The Association's campaign, when first announced at their news conference in December of 1996, was called "Patients First". By their next news conference in January of 1997, the title had been revised to - "Putting Patients First". Karen M. Ignagni, president of the AAHP, said that their use of the identical title was "merely coincidence", and that confusion was unlikely. The Council has now filed an application to register the phrase "Putting Patients First" as a trademark in order to compel the Association to stop using it.

The NHC document says that all patients have a right to "timely access to specialty care" and are "entitled to a reasonable choice of health care providers", with an opportunity to change doctors if they are dissatisfied. The philosophy (their word) of the AAHP is " that PATIENTS SHOULD HAVE THE RIGHT CARE, AT THE RIGHT TIME, IN THE RIGHT SETTING" (their capitalization).

The NHC believes that patients are entitled to know the criteria used by HMO's to select the doctors and hospitals that enrollees must use, and that patients should be told whether they can continue seeing a doctor who leaves the network or was never part of it. The AAHP says, "PATIENTS SHOULD HAVE A CHOICE WITHIN THEIR HEALTH PLANS OF PHYSICIANS WHO MEET HIGH STANDARDS OF PROFESSIONAL TRAINING AND EXPERIENCE -- and that informed choice, and the freedom to change physicians, are essential to building active partnerships between patients and doctors". (The capitalization is again theirs.)

The NHC is concerned about the financial arrangements among doctors, hospitals, laboratories, and HMOs. Thus, patients should have a right to know how their doctors are paid. They should be told of potential conflicts of interest between the doctor's earnings and the patient's treatment requirements. Patients should know about financial incentives and clinical rules that cause doctors to provide less than the patient may need. The AAHP says, "We believe that CONSUMERS HAVE A RIGHT TO INFORMATION ABOUT HEALTH PLANS AND HOW THEY WORK". (Still with the capitals.)

And the AAHP "philosophy", as weak and as vague as it is, is in no way binding on the member organizations for which the organization is a mouthpiece. The practices of HMOs frequently fall short of even this pathetic mark. According to the president of the American Cancer Society, Dr. Miles P. Cunningham, "The hallmark of managed care is rationing in one form or another, subtle rationing or overt rationing. It's driven by costs."

HMOs would rather have standards for quality of care that they set for themselves, hoping that it will be sufficient that "the industry" is opposed to outpatient mastectomies for breast cancer, that it promises to cover emergency care, and that it exhorts health plans not to limit what treatment options a doctor may discuss with a patient. Actual member organizations are not required to follow these standards. In Congress and in state legislatures, there a number of bills in process that would set stricter requirements on HMOs, with financial penalties for non-compliance.


This report was condensed from an article in the New York Times, July 8, 1997. The National Health Council does not have a web site; they may be contacted at 1730 M Street, NW, Suite 500, Washington, DC, 20036; (202) 785-3910 for voice, (202) 785-5923 for fax.


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This page was posted July 12.

Layout revised September 30.

Last revised January 31, 1998