[quote=bearishgurl]
Another hint: I’ve had co-workers and friends who have died due to misdiagnosis and/or too many hoops to jump through for care and not enough time on (or off) the books to play the waiting game. All were with “Kaiser” HMO.[/quote]
While I value your anecdotal comments, we have to put things into context.
One big issue is PPOs do not have direct control over their physicians. So if there is a bad outcome, or if there is a problem such as misdiagnosis, the word on the street would be “Dr. So-and-so did this to me! Dr. So-and-so is a bad doctor.” The word on the street would not be Anetna is a BAD insurance because it contracted with Dr. So-and-so.
But Kaiser is a HMO that hire their physicians. Therefore, if there is a bad outcome, then we have “Kaiser did this to me! Kaiser is a BAD HMO.”
So let’s think this through in real numbers.
Now Kaiser is the 800 lb gorilla in southern Cal, so out of say 12 million souls in SoCal, 1/4 are Kaiser members.
So that’s about 3 million.
Say Kaiser does a good job 95% of the time. That still leaves 150,000 anecdotal complaints out there. And these 150,000 will repeat that bad experience time and time again. And when these 150,000 report the events, they will not name this specific doctor that errored, it would be a blanket Kaiser problem.
Now let’s go back to Aetna. Let’s say in SoCal it has 1 million members. And its contracted providers does a good job also 95% of the time. Just by the numbers, we are now looking at 50,000 people going around complainting about their mistreatment. But because of the nature of the PPO structure, that 50,000 will likely blame the specific doctors that errored, not Aetna in general. Because there is no such thing as an “Aetna physician.”
There is always a personal story behind each and every anecdotal story. And they are important in their own ways. But we need to be careful when we try to apply anecdotal stories into the context of good vs bad care.
Overall, by numbers, per the US News and World Report, Kaiser SoCal scored a 84.1 out of 100, landing it #71 out of 239 health plans ranked.
But Aetna, and remember this is the same insurance giant that tried to raise rate by over 30% last year in Cali, scored 77.8 and landed #208 out of 239 health plans ranked.
