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Lifestyle Saturday October IMS II Clarifying views on HMO problems By Peter MI I took a lot of heat following cation of a recent column on Health Maintenance Organizations HMOs In which I criticized for profit health plans In turn I was criticized for throwing the proverbial baby out with the bath water Like major league baseball tea ms not all HMOs arc ere a ted equal Some arc profit other arc called staff models group mod els or 1PA Individual Practice As sanation models Such designations reflect the role of the primary care physician In the system As a salaried employee a contracted physician member of a group practice or con in solo practice MDs arc paid by the HMO by one or a com blnation of three methods salary fee for service or capitation teed ixcd price per enrolled patient Few experts have questioned the quality of medical care thai is theo retically delivered HMOs The is sue that has raised conflict of interest flags is the manner in which the doc In New Journ of tint Special Report of Ihe University of Pennsylvania wrote The economic depends on ability lo keep the use of health can resources with in a budget Because physicians dcci govLrn the use of resources HMOs use a variety of nisms to encourage conscious be by providers These are a par important influence on the behavior of physicians These lives may take the form of penalties rewards or both Physicians may be at risk of losing a percentage of their payment that is withheld in the case of deficits or they may be rewarded with bonuses in the case of surpluses Dr asks Do financial in induct physicians in HMOs to act in their own pecuniary self in and therefore to compromise patient care Not necessarily he concludes However the relation be financial Incentives and physi behavior needs be clarified In particular patients need to know more about Ihe HMO plans offered lo them the major point In my original column In another article in Ihe New En gland Journal Douglas of the Medical College of ma urges thai HMOs disclose lo the public the arrangements they have with their doctors Why For the following reasons Although actual effects of these arrangements are poorly under stood and notoriously difficult to study subscribers believe thai the quality of their care may be ail Opponents hold ih in some HMOs the us nancial pressures lo limil may be in plan Consumers have a right lo choose between saving that resull from such plans and the greater choice or absence of cost saving incentives in other plans Inexntivis to withhold services inlroduce ethical dilemmas into the practice of medicine These dilcm mas in prepaid plans are much less apparent than those in the lee for vice system which makes it obvious physician has an interest in selling any specific requirements regarding specialty consultations and use of hospitals indicate the re on consulting out plan physicians describe the pool of con sultants and the method of obtaining exceptions enumerate the appeals procedure for emergency exceptions and explain the incentives or disln for the primary care Of the million people now en rolled in HMOs percent are en rolled in for profit plans In many HMOs the primary care physician is the gatekeeper the influence oncost containment Such a the patient At present there is no accepted code by which the his dual rob s as guard of thi HMO s and patient advocate guidelines the king JuiK POLLYS POINTERS porting materials such as Saw dm I keep the pile damp and turn it or mix up after flic or six week on your garden far winter Ihcn till the soil la the spring Again tbr will mix soil they re saredded but can be lell whole Dry leavn can alia be saved as mulch either whole or shredded rouhli with egg oiled for eggs Are leaves OK to add to compost By Polly Usher fOLIY Should I put whole into my compost pile or should they be ground up Should I add anything along with the leaves JW DEAR J Whole leave be mixed Into your but a large quantity of leaves will break down into rich compost faster shredded chopped To speed decomposition Hot you thai good mix Get A Tan Look Good Foot Great A Mos Unlimited 3 Unlimited 6 Unlimited SIMM The Tanning Centre Nells DRIVING SCHOOL by Ontmto Safety leaf NEXT COURSE STARTS NOVEMHER 14 TO DECEMBER Monday Wednesday Nights 630 to For Information About Courses or Private Lessons phone 8772671 Georgetown To help us introduce out newest stylist LINDA SCOTT we are ottering you our 40 perm lor a low price of SENIOR JUNIOR STYLISTS PRICES AVAILABLE until Fire safety reminder fire mjoa I mm thy If have line over the pan with a lid or use in extinguisher a Ml me mil includes the Idler II Turn iff the licit the pin off the hoi burner Leave the lid until pan is coo It is wise in the fire tlcpinmcnljust in i Tire spread itimiih vents nine area Li By Glenda Hughes Sales Rep 8730300 p give a only lo give help in una ruse image of real especially In this area I it ilready been done over on misinformation I think 1 have succeeded as well js tan enpected pitfalls than 1 dreamed of it r 1 had the nlghlnnra a snle it brought fnrth purchaser would agent turn at Ihe thought It was dilficult sale for everyone concerned as there were two of ibli at Ihe same lime Usually this goes smoothly but will estiblished knew the pes When Ihere in Hint ikes tit sale The ire id torn it if this lithe So 1 I til I il Hi I I tilt v i I Inn t I r if vou trust I i I Ked in id v speed nil ever tin tint fee SPECIAL PRICE s 12exp 4 lnexp 5 24exp 8 II FREE Double Prints 2 3Ax5 or Double Size 5x7 CAN YOU BELIEVE THIS at GREENMEADOWS GARDEN CENTER BUY 2 GET 1 FREE ON ALL INSTOCK PRODUCTS GREENMEADOWS GARDEN CENTER Ave Unit A Georgetown 8772112