HOSPITALS AND HMOs

For years, Cape Girardeau's two hospitals have stood firm in resisting proposals from health-management organizations. Officials from both Southeast Missouri Hospital and St. Francis Medical Center have thought discounts offered to various HMOs would result in cost shifting to other paying parties.

Earlier this year, the hospitals and area physicians formed their own physician-hospital organization, MedAmerica Health Net. Then they offered a managed-care insurance product through Blue Cross-Blue Shield.

After a year of trying to recruit a Cape Girardeau hospital to its managed care program, Humana Health Care Plans, a national managed-care company, has chosen Southeast Missouri Hospital. That means Humana's clients will receive a bigger discount at Southeast, even though the hospital hasn't agreed to discount its rates. The difference will be made up by Humana.

But this divide-and-conquer strategy may not work for Humana, because both hospitals say they are standing strongly behind their MedAmerica Health Net product. St. Francis Medical Center has said it won't sign on with Humana but will offer the discounted rates to Humana customers, not to the company.

The real issue is how this will impact other paying customers. If the hospitals maintain some kind of equity among all the insurance companies they deal with, patients are likely to be the overall beneficiaries. Somebody has to pay the price for deep discounts.