Faculty and staff members voiced their concerns about the legality and propriety of the University's recently implemented health-care plan Tuesday night.
In a forum sponsored by the Duke Association of Scholars, employees discussed their experiences with the Duke Managed Care plan, which replaced the Duke Comprehensive Plan as the University's primary health-care provider in July.
The change, which was made to halt escalating health-care costs, means that employees now choose between two health-care options: the existing health maintenance organization Kaiser Permanente, and the Duke Managed Care Plan, administered by Sanus-New York Life.
Under both managed-care options, patients choose a primary-care physician from 35 Medical Center faculty and at least 45 affiliated community doctors, who will administer general health care and refer patients to specialists for problems outside of routine practice.
This marks a significant change from the previous comprehensive plan, which covered almost all employee medical expenses incurred at the Medical Center for the past decade--without the use of primary care physicians or a structured referral system.
At the forum, a group of 35 faculty and staff presented several concerns about the administration of the health-care plan, most of which echoed protests that have been levied against the plan since its inception. At the same time, many seemed enthusiastic about offering solutions and alternatives for those practices seen as problematic.
Many employees took issue with their interaction with Sanus, citing poor customer service response as well as problems with the third-party administrator's policy of not disclosing information about the incentives it gives physicians, which may affect patient care. Law professor Donald Horowitz told several anecdotes about what he said was inadequate health care, adding that "People are constantly calling me with complaints. This is not a field I care to work in."
Participants urged each other to call Sanus' toll-free customer service number to register their complaints and prompt policy change, and some suggested taking action through state legislative bodies to guarantee disclosure of information to patients.
Several faculty members also called for greater choice in health-care plans and policies, citing Kaiser as an insufficient alternative to the Duke Managed Care plan. Horowitz, for example, criticized the drastic shift from the comprehensive plan to managed care, arguing for a move to "middle ground" such as increased co-payments or changes in coverage as a better option, while others called for an increase in the number of health-care providers available through the University.
Toby Kahr, associate vice president for human resources, said that the University has been examining options, including offering plans from two HMOs, Healthsource and PHP, but defended the managed-care plan as a necessary solution to skyrocketing health-care costs. "Under the old plan, we were losing $750,000 each month," Kahr said. To compensate for this loss, the University would have had to increase insurance premiums by 30 to 40 percent, he added.
A drastic increase in health care's cost to employees is unacceptable because it would prohibit some employees from gaining access to health care, Kahr said. "I just don't know how you could live with that."
Continuing a debate that began with the publication of an essay in the Duke Dialogue last May, Horowitz expressed serious concerns about the quality and legality of care provided by Sanus. Because the University is responsible as an employer for the well-being of its beneficiaries and as an institution with a hospital which provides the health care itself, it is guilty of having a conflict of interest, Horowitz said. "The University's caught in a structural conflict of interest from which it needs to extricate itself," he said.
Administrators have defended their role in overseeing the health plan, arguing that no member of the administration is responsible for both the hospital and its employees. This spring, an external review of the health plan will be conducted in order to assess the quality of health care and the university's role in administering it.
Not all employees present expressed full dissatisfaction with the plan. Conrad Fulkerson, assistant clinical professor of psychiatry and behavioral sciences, said that while he is concerned with the future of health care, if people are well-informed and know what kinds of questions to ask, they can take advantage of their health care. "I think we have an opportunity here if we know what the questions are," Fulkerson said. "I can't help but think that being explicit and understanding these issues would be beneficial to everyone."
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