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Review the adequacy of consumer protections available through
managed health care and the need to enhance those protections
through statutory revision.
The trend toward managed care has significantly changed the delivery
of health care in the United States. While indemnity policies
have the advantage of offering consumers greater choices in health
care services, managed care has resulted in cost savings that
make quality health care available to more people. The Texas
managed care market has grown over the last four years, with the
number of HMO enrollees increasing by 64 percent since 1992.
There are currently 40 basic service HMOs and 16 single service
HMOs, with 12 percent of the Texas health care market. But the
committee concluded that it is imperative that the cost containment
resulting from a competitive HMO industry not reduce or endanger
access to quality health care services.
The report makes a number of recommendations designed to protect
consumers by amending existing statutes and codifying agency rules
in the following areas: determination of medical necessity, access
to care, consumer protections, quality of care, physician and
provider contracts, licensing regulations, and solvency regulations.
The recommendations include: