147           
HOUSE OF REPRESENTATIVES             H.C.R. NO.            
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
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                     HOUSE  CONCURRENT
                        RESOLUTION
  REQUESTING THE INSURANCE COMMISSIONER AND THE DEPARTMENT OF
    HEALTH TO STUDY AND DETERMINE THE FEASIBILITY OF VARIOUS
    OPTIONS RELATING TO MANAGED CARE IN HAWAII.



 1        WHEREAS, managed care systems have changed the landscape
 2   of American health care within the last decade as the following
 3   facts for 1997 attest:
 4   
 5        (1)  Enrollment in health maintenance organizations
 6             reached 83,700,000;
 7   
 8        (2)  Enrollment in preferred provider organizations
 9             reached 89,100,000;
10   
11        (3)  Insurance companies owned 60.4 per cent of preferred
12             provider organizations;
13   
14        (4)  Over seven hundred fifty health maintenance
15             organizations and over one thousand preferred
16             provider organizations were operating in the United
17             States; and
18   
19        (5)  Managed care organizations enrolled 46.7 per cent of
20             the Medicaid population, or 14,600,000 people and
21             14.9 per cent of the Medicare population, or
22             5,600,000 people;
23   
24   and
25   
26        WHEREAS, as managed care organizations began to create
27   cost savings as they were designed to, dissatisfaction with how
28   some managed care organizations have accomplished that by
29   possibly compromising on the approval of and accessibility to
30   specialized health care for patients has become more
31   widespread; and
32   
33        WHEREAS, a sign of the trend is the increasing number of
34   "patient protection" or "consumer-patient bill of rights" laws
35   enacted by the states -- thirty-nine such laws were enacted
36   between 1994 and 1998 -- to protect against questionable
37   practices by managed care organizations; and
38   

 
Page 2                                   147               
                                  H.C.R. NO.            
                                                        
                                                        


 1        WHEREAS, of particular concern is the practice of using
 2   certain types of nurses or nonphysicians, in place of primary
 3   care physicians, to treat patients in a managed care setting;
 4   and
 5   
 6        WHEREAS, certain concerns arise regarding the use of such
 7   nurses or nonphysicians in place of licensed physicians as the
 8   patient's primary care giver in managed care organizations,
 9   including:
10   
11        (1)  If such a nurse is employed under contract to the
12             managed care organization, it creates a possible
13             conflict of interest where the nurse may owe or feels
14             should owe the organization a fiduciary duty to
15             contain costs at the expense of a patient's well-
16             being;
17   
18        (2)  Such a system using certain nurses in this way may
19             actually add to health care costs by increasing the
20             administrative burden on the organization;
21   
22        (3)  Such nurses may lack experience treating patients and
23             may not be qualified; and
24   
25        (4)  Such nurses may violate patient confidentiality by
26             requesting patient records without permission;
27   
28   and
29   
30        WHEREAS, it is in the interest of the people of the State
31   of Hawaii to resolve these issues satisfactorily; now,
32   therefore,
33   
34        BE IT RESOLVED by the House of Representatives of the
35   Twentieth Legislature of the State of Hawaii, Regular Session
36   of 1999, the Senate concurring, that the Insurance Commissioner
37   and the Department of Health are requested to study and
38   determine the feasibility of various options relating to
39   managed care in Hawaii; and
40   
41        BE IT FURTHER RESOLVED that the Insurance Commissioner and
42   the Department of Health are requested to specifically examine
43   the feasibility of the following issues:
44   

 
 
 
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                                  H.C.R. NO.            
                                                        
                                                        


 1        (1)  Allowing the patient to choose a physician or a nurse
 2             to manage the patient's health care in a managed care
 3             setting;
 4   
 5        (2)  Allowing the managed care nurse to become involved in
 6             the care of the patient only:
 7   
 8             (A)  Upon the request of the patient's physician; or
 9   
10             (B)  After six months but subject to the patient's
11                  choice of managed care nurses; and
12   
13        (3)  Not allowing managed care in the State;
14   
15   and
16   
17        BE IT FURTHER RESOLVED that the Insurance Commissioner and
18   the Department of Health are requested to report findings and
19   recommendations, including any necessary proposed legislation,
20   to the Legislature not later than twenty days prior to the
21   convening of the Regular Session of 2000; and
22   
23        BE IT FURTHER RESOLVED that certified copies of this
24   Concurrent Resolution be transmitted to the Insurance
25   Commissioner and the Director of Health.
26   
27   
28   
29                         OFFERED BY:  ____________________________