File #: Res 1123-1999    Version: * Name: HMO Treatment, Doctors Approval
Type: Resolution Status: Filed
Committee: Committee on Health
On agenda: 12/16/1999
Enactment date: Law number:
Title: Resolution commending the action by the United Health Group that allows doctors and patients to determine, without HMO approval, the manner in which treatment is provided.
Sponsors: Pedro G. Espada, Tracy L. Boyland, Martin Malave-Dilan, Lloyd Henry, Margarita Lopez, Helen M. Marshall, Philip Reed, Angel Rodriguez, Thomas White, Lucy Cruz, Wendell Foster, Sheldon S. Leffler, Walter L. McCaffrey, Stanley E. Michels
Council Member Sponsors: 14
Res. No. 1123 Title Resolution commending the action by the United Health Group that allows doctors and patients to determine, without HMO approval, the manner in which treatment is provided. Body By Council Members Espada, Boyland, Malave-Dilan, Henry, Lopez, Marshall, Reed, Rodriguez, White, Cruz; also Council Members Foster, Leffler, McCaffrey, Michels Whereas, According to the American Association of Health Plans, in 1996, over 67.5 million Americans were projected to be enrolled in Health Maintenance Organizations (HMO's); and Whereas, According to a November 14, 1999 Newsday article, 2.1 million New York City residents are covered by managed care, more than any other type of health insurance; and Whereas, Most HMO's have instituted internal procedures, whereby a panel of administrators reserves the right to overrule a physician's determination that a patient needs a specific treatment or that the patient needs to be admitted to a hospital; and Whereas, United Health Group ("UHG") is an HMO and the second largest health insurer in the nation, with a presence in all 50 states and a customer base of over 14.5 million patients; and Whereas, The UHG states that it has 409,315 customers in New York City; and Whereas, According to an article in the November 9, 1999 issue of The New York Times (the "Times article"), the UHG announced that it was returning decision-making power regarding patient care to physicians; and Whereas, A November 9, 1999 statement issued by the UHG declared that it was expanding its Care Coordination initiative which "obsoletes certain programs associated with traditional medical management, such as pre-authorization for inpatient hospital procedures, and enhances clinical decision-making between the patient and physician"; and Whereas, According to the Times article, physicians and consumer advocates hailed the UHG decision, as part of a growing, positive trend among HMO's to abandon the practice of micro-managing physician decisions; now, therefore, be it Resolved, That the Council of the City of New York commends the action by the United Health Group that allows doctors and patients to determine, without HMO approval, the manner in which treatment is provided. Referred to the Committee on Health. LS#2483 JO:PS:ts H:NEW2resolution-hmo united health group- espada(2) |1013| |1013| |1013|