we believe they should be permitted to do so. We have no objection to ownership of an HMO by physicians and other professionals. However, safeguards must be taken that will prevent their ownership of the HMO from abusing utilization. HARVARD CENTER FOR COMMUNITY HEALTH Reponse. We do not feel that one should lay down specific percentages to achieve a balance between professionals and consumers. This again, should be part of the joint process referred to in the answer to question 9A. It is also a function of the area of responsibility. Authority should be vested in those who have the responsibility for the various areas. In any event, the society can not abdicate its responsibilities for seeing that all its members have adequate access to medical care. This, again, is the function of the planning agency. FEDERATION OF AMERICAN HOSPITALS Washington, D.C. Response. Same as answer to 9.A. AMERICAN NURSES ASSOCIATION, INC. New York, N.Y. Response. The development of standards of health care are the responsibility of each profession involved in providing that care. AMERICAN SOCIETY OF MEDICAL TECHNOLOGISTS Houston, Tex. Response. Cannot answer. 9.C. What should be the role of physicians and other professionals in the ownership of HMO's? DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Response. In keeping with the goal of a pluralistic system of health care delivery, there is a clear intent to foster a variety of organizational forms of HMO's. In the context, physicians and physician groups may participate in HMO ownership and management in the same way as hospitals, consumer groups, or public entities. The physicians and other professionals, thus, enter fully into the risk-sharing inherent in the HMO concept. The Ross-Loos Medical Group in Los Angeles is a pioneer HMO prototype example of this organizational form. FAMILY HEALTH PLAN OF SOUTHERN CALIFORNIA Response. Unfortunately, if physicians own HMO's, they will tend to give the consumer what they think he should have. I do not believe that ownership should be limited to anyone. Policy making and management should be. There should be objective policy making. Management, the physicians and the consumers should be kept out of policy making alone. They can own it, but they shouldn't control it. This is a very interesting list of questions and FHP has been through all these problems. FHP has a Board of Directors consisting of two consumers, two doctors, and three outside professional managers, plus an Advisory Committee of consumers. We have a dynamic, aggressive marketing component, a management development system, and educational program. Please see enclosed literature on your recent seminar-Putting Together the HMO. We have audio visual films and tapes if you wish, on this subject matter. GROUP HEALTH ASSOCIATION, INC. Washington, D.C. Response. The best approach, it is believed, is to have HMO's owned by the enrollees-with this corpus contracting with a partnership or association of physicians and other professionals. GROUP HEALTH COOPERATIVE OF PUGET SOUND Seattle, Wash. Response. Same as answer to 9.A. GROUP HEALTH PLAN, INC. Saint Paul, Minn. Response. HMO's should be nonprofit corporations and the professionals should not have ownership of it. There should be strong statutory provision for consumer representation in any HMO. KAISER FOUNDATION HEALTH PLAN, INC. Oakland, Calif. Response. Same as answer to 9.A. WESTERN CLINIC Tacoma, Wash. Response. No answer supplied. HARVARD COMMUNITY HEALTH PLAN Boston, Mass. Response. This is a difficult issue. Although most hospitals in this country are voluntary, non-profit institutions, medical practice has had a strong entrepreneurial character. It is likely that physicians and other professionals will view HMO's as a logical extension of this latter tradition and will become actively involved in their development and operation. Physician HMO ownership raises serious conflict of interest questions. A more desirable arrangement would provide for arms-length contractual ties between physician groups and an independent HMO entity. BLUE CROSS ASSOCIATION Washington, D.C. Response. Same as answer to 9.A. NATIONAL ASSOCIATION OF BLUE SHIELD PLANS Washington, D.C. Response. No answer supplied. HARVARD CENTER FOR COMMUNITY HEALTH Boston, Mass. Response. The ownership of HMO's may vary. Some may be owned by physicians, some by public corporations, some by hospitals and some by combinations of various groups. Flexibility to meet individual circumstances is to be encouraged. Whatever the ownership, however, public accountability must be required and the establishment of the HMO must be in accord with the program of the planning agency discussed in question 6. On the issue of public accountability the attached testimony may be of interest. FEDERATION OF AMERICAN HOSPITALS Washington, D.C. Response. Same as answer to 9.A. AMERICAN NURSES ASSOCIATION, INC. New York, N.Y. Response. We would see the consumer concerned with policies relating to financing, availability of services, and development of the organization. AMERICAN SOCIETY OF MEDICAL TECHNOLOGISTS Response. The HMO should not be primarily profit-making organizations. There should be a set amount of income to be returned for capital improvements and personnel advancements. Profit to any member of the HMO should be in the form of a set salary. |