UnitedHealth Not First To Put Medical Decision-MakingIn Hands of Doctors; Kaiser Permanente Did...

OAKLAND, Calif.--(BW HealthWire)--Nov. 8, 1999--

Senior physicians of Kaiser Permanente California are available to comment on today's news reports that UnitedHealth is poised to announce a decision giving doctors the final say on what care is medically necessary. Far from being a new

At Kaiser Permanente, physicians make medical decisions -- not insurance administrators -- and that has been a key principle since the health care delivery system was founded in 1945.

The principle of physician decision-making at Kaiser Permanente was first articulated in the 1940s, according to the book "Can Physicians Manage the Quality and Costs of Health Care? The Story of The Permanente Medical Group" by John G. Smillie, MD (McGraw-Hill, 1991).

Physician decision-making became a cornerstone of the later "Tahoe Agreement" of 1955, when the current makeup of Kaiser Permanente was created with a unique structure through which Kaiser Foundation Health Plan and the Permanente Medical Groups contract with each other on a mutually exclusive basis. This preserves the physicians' role in making medical decisions. This agreement grew out of conflicts that potentially threatened physician decision-making in earlier years.

Representatives from Kaiser Foundation Health Plan and from the two Permanente Medical Groups in California are available by phone to comment on the UnitedHealth decision.

Kaiser Permanente, California is a prepaid, group practice health maintenance organization (HMO) serving more than 5.8 million members throughout the state. More than 7,000 Permanente medical group physicians in both The Permanente Medical Group (TPMG) in Northern California and the Southern California Permanente Medical Group (SCPMG), as well as 55,300 Kaiser Foundation Health Plan and Hospitals employees, provide care to Health Plan members. There are 28 major medical centers organized into 12 service areas throughout California.