Summary: Health insurance statutes and regulations in 15 states, which collectively account for about two-thirds of all Americans enrolled in health maintenance organizations, address consumers' concerns about access to health care and information disclosure with differing approaches, scope, and form. For example, California and Minnesota address seven types of patient protection: coverage of emergency services, access to obstetricians and gynecologists, access to pediatricians, access to other specialists, continuity of care for enrollees whose providers leave their plans, drug formularies, and patient-provider communication. Colorado addresses three of these protections, Massachusetts only one. The most prevalent protections address open patient-provider communication, emergency care coverage, and access to obstetricians and gynecologists. Only four states guarantee direct access to pediatricians. Continuity-of-care provisions differ; about half of the states specify pregnancy as a condition subject to this coverage. An effective approach to ensuring quality and efficient health care for managed care enrollees would balance the regulatory assurance of minimum standards with quality-based competition among providers.
