Department of Civil Service
with Health Care Services Provided by HMOs in the New York State
Health Insurance Program
More than 20 HMOs participate in the New York State Health
Insurance Program, which provides health insurance coverage to
State and local government employees and their dependents. In
1993, these HMOs were paid nearly $260 million in premiums for
services provided to about 85,000 members of the program.
We examined certain aspects of member satisfaction with the
health care services provided by HMOs. According to our random
survey of selected members, the members were generally
satisfied with the overall performance of their HMOs. However,
about 36 percent of the members were dissatisfied with some
aspect of their access to health care, such as their access
to specialists. We note that the Department of Civil Service,
which administers the New York State Health Insurance Program,
does little to actively monitor member satisfaction with
HMOs; as a result, the Department may not be aware of problems
that need to be addressed. For example, because of the nature of
the Department's reporting requirements, most of the grievances
filed and complaints made by members against HMOs are not
reported to the Department. We recommend that the Department
more actively monitor member satisfaction with HMOs.
For a complete copy of 95-S-112 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.