HMOs OFFER VALUABLE ALTERNATIVE

I just finished Scott Moyers' July 22 article about health maintenance organizations (HMOs) in the Cape Girardeau area.

I think it was unfair to portray HMOs as a terrible development in modern medicine. Many people in Southeast Missouri would benefit greatly if we had HMO doctors in the area. My husband currently carries health insurance through Healthlink. This past year I elected to go to St. Louis for surgery because I wanted to go to an HMO doctor at an HMO hospital.

I searched the Cape Girardeau area and luckily found an HMO laboratory to do my lab work before surgery. I had excellent care (as we have always had in the past with HMO doctors and facilities) and did not owe one cent to anyone for these services. If I had decided to go to a doctor and hospital here, I would have owed several thousand dollars.

I propose that the real reason we do not have a strong HMO presence here is because of the greed of the medical community in the Southeast Missouri area. Many of the specialists are not even preferred provider organization (PPO) doctors, which would reduce patients' costs considerably. This is a matter of choice by the physician. I have discussed this with many medical-office employees and have been told that the doctors choose not to enroll in an HMO or PPO plan because it would cost them money. Since the doctor has plenty of patients or is one of the few doctors in the area with that specialty and no competition, the physicians choose not to participate in an HMO plan, which allows them to make all of the money offered by the patient without the cost of subscribing to an insurance plan. I understand this, because physicians have spent many years and much money for their training, not to mention the cost of running a practice.

However, I feel it would be a great asset to the people in the community who belong to an HMO to be able to receive care from HMO doctors and facilities in the area.

I have recently read that Southeast Missouri Hospital has become an HMO facility. My husband and I suspect Southeast Missouri Hospital became an HMO facility because of the competition offered by St. Francis Medical Center's decision to deliver babies. Hooray for competition.

I would like to clarify why my husband and I feel so strongly pro-HMO and why it would benefit families in the area, especially employees of some of our area's large employers.

Two years ago my daughter had a severe accident. She was sent to St. Francis Medical Center by ambulance. She was seen by three physicians.

Many lab tests and X-rays were taken. Although we pay to have the privilege of going to HMO and PPO providers, this is how it broke down: St. Francis was a PPO provider, so we had to pay 10 percent of the hospital cost instead of nothing that would have been owed to an HMO. We had to pay 100 percent of the cost of all three of the physicians at the hospital and later during follow-up office visits (they were specialists, so they have no competition). We had to pay 100 percent to the ambulance company (it does not participate in any plan). For the lab and X-ray work, we paid 10 percent because they were done by PPO providers.

We owed several thousand dollars to the local medical community, whereas had this accident happened near almost any hospital in St. Louis, we would have possibly owed a couple of hundred dollars.

Many people who do not subscribe to an HMO would say, "So what? We have to pay at least 20 percent to doctors" or "We don't have health insurance, so we always have to pay 100 percent." Please let me remind you, though, that we are paying to belong to a system which will reduce our medical costs. I believe many of us would choose HMO doctors and facilities in the area if given the choice.

Nancy Propst of Jackson is a teacher.