Objective: A variety of legal sources require HMOs to disclose to members how they pay their physicians. These disclosure requirements are intended to inform members of the potential conflict of interest created by physician financial incentives. This study is an initial, qualitative assessment of how HMOs are complying with these legal requirements, what they are disclosing, and how effective these disclosures are in meeting the intended purpose of these laws. Design: Twenty key informants with extensive experience with or knowledge of disclosure practices were identified and interviewed, consisting of academics or public policy analysts (8), regulators (5), health plan representatives (4), patient and consumer advocates (2), and one private lawyer. Nine participated in a guided discussion in which they addressed: purposes and reasons for disclosure, current disclosure practices and their reasons, experiences with these practices, pro's and con's of alternative practices, and how well current practices meet the objectives of disclosure. Examples of existing disclosure statements in use were collected, amounting to 33 disclosure statements from 13 private insurers and 5 government authorities. Findings: Plans began disclosing financial incentives for legal, not educational, reasons. So far, these disclosures have produced virtually no detectible response from members. Disclosures are often either too brief or too complex to be understood. Moreover, the most relevant information -- how one's own physician is paid -- is usually missing from disclosures. Implications: Disclosure requirements should be revised to better meet their intended objectives. A layering approach is recommended in which disclosures are made in stages.
Learning Objectives: At the conclusion of this presentation, the learner will be able to: 1. Recognize key issues related to financial disclosure policy
Keywords: Managed Care, Ethics
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.