HMOs, A Pox on Our Houses

Pauline Furth, M.D.

A RECENT AND appalling indication of how the profit motive exclusively drives so-called “Health Maintenance Organizations” (HMOs) concerns the chicken pox vaccine.

Chicken pox is a viral infection, highly contagious, of approximately two weeks’ duration. It is far more serious in adults than in children, but may lead to serious diseases such as pneumonia, encephalopathies and the fatal Reye’s Syndrome.

Ten thousand persons are hospitalized each year and about 40 deaths occur. There is a loss of day-care time, school time, as well as parents’ work time which is often a vital consideration.

All the HMOs have widely advertised their interest in “preventive care.” Chicken pox vaccine has been approved and recommended by the Food and Drug Administration (FDA), the federal government, the state of California and the American Academy of Pediatricians.

Now comes Pacific Care (Secure Horizons), which does not recommend the vaccine. The reason given is “that it doesn’t build life long immunization.” (LA Times, 4/3/96) Would we have to wait seventy-five more years to prove its efficacy?

The actual reason is otherwise. Merck and Co. hold the chicken pox vaccine patent, and it costs the medical profession about $39 per injection. Compare this to the cost, by the same company, of three combined immunizations of MMR (measles/mumps/rubella) for $13-$15 less for all three.

All the managed care corporations are trying to hold down their Medical Loss Ration (MLR)–the amount of their medical costs versus the premiums. This factor, of course, is very important to their stockholders.

Pacific Care’s MLR was higher in 1995 than the previous year, and they have apologetically sent literature to their investors assuring that they hope to hold down their medical costs in this year. Greater returns to their CEOs and stockholders will come, even at the expense of children who will have less Secure Horizons than before.

ATC 65, November-December 1995