Easy out of network access will significantly drive up premium costs for people in HMOs. Instead of this access change, guaranteed choice of plans and strengthened enforcement of current consumer protections can provide both cost savings and quality care along with choice. The debate over choice - cost increases must be considered in the solution. Much debate about HMOs so far in the North Carolina General Assembly has focused on the amount a HMO patient should have to pay if they go out of their HMO network. Many people want choice of providers but, when they are told their premiums will rise to give them such a choice, a substantial portion say they would stay with HMO network providers rather than pay extra costs.
Some people are, however, willing to pay extra for more choice.
The answer is not to change HMOs so that patients may leave the HMO network any time for a minimal penalty - this would result in a large increase in costs that would be paid for by everyone whether or not they were willing to pay more for provider choice. Rather, choice can be given to people by requiring insurance plans to offer along with HMOs another health plan where people can get health insurance and go to any provider without paying a penalty. This plan will cost more than the HMO but people to whom provider choice is the primary concern can elect this type of health plan. This allows HMOs to contain costs and monitor quality through control over their provider networks while, at the same time, allowing people who value choice of providers highly a guaranteed option of enrolling in plans that will allow them that choice. It does not take away the ability of people to choose a lower cost HMO when they are willing to restrict their choice of providers.