Published: June 19, 2009 06:35 pm         

FLASHPOINT: General Assembly holds health-care professionals accountable

Have you been feeling over the past several years that the patient is being overlooked in the health care process? You may want to join a growing number of citizens in saying it’s time for that to change. During the 2009 session, the Indiana Legislature passed House Resolution 91. This is a resolution that encourages the American Medical Association (AMA) to develop a Health Insurer Code of Conduct setting forth clear and concise principles to address both medical care policies and payment issues. The acceptance of HR 91 is a sign that both Republicans and Democrats believe this change is overdue.

Health insurers have become far too active in patient care—decisions that many believe should be between the patient and the health-care provider. The delay of reimbursements to providers and the refusal to cover certain therapies have allowed insurance companies to exert undue influence over the medications and procedures patients may receive.

The AMA’s resolution attempts to address these practices by passing a Code of Conduct for health plans, thus protecting the provider/patient relationship, improving transparency in areas and ensuring corporate integrity within the health insurance industry world. This Code of Conduct will require that a health plan clearly outline for the consumers what is included in their health coverage, thus allowing greater transparency and understandability.

A voluntary Code of Conduct is not intended to unravel the practices of managed care, but to empower health-care professionals to act in the best interests of their patients: without fear of retribution, without having to undergo “over-the-top” scrutiny and immediate rejection of their determined plan of care; and with the knowledge that any program implemented to promote “quality” is peer reviewed, risk adjusted, and quality driven.

Most persons and organizations associated with health care, from healthcare professionals to medical device and drug-makers, are expected to follow a code of conduct, that is, except for health insurers. Examples include:

• Hippocratic Oath for physicians serves as basic code of conduct — “above all, do no harm”.

• American Medical Association (AMA) “Principles of Medical Ethics” and ethical opinion “Gifts to Physicians from Industry”.

• Advanced Medical Technology Association (AdvaMed) Code of Ethics on Interactions with Health Care Professionals.

• Pharmaceutical industry’s “PhRMA (Pharmaceutical Research and Manufacturers Association) Code on Interactions with Healthcare Professionals”

• American College of Clinical Pharmacy “Pharmacists and Industry: Guidelines for Ethical Interactions”.

It is expected that a Health Insurer Code of Conduct should include several clear general principles for the health insurance industry to follow when establishing policies and practices impacting the medical care received by patients. Without these guiding principles, Indiana health-care providers eventually could be forced to adhere to only the dictated practices of the health insurance industry rather than providing the quality of care expected by Hoosiers.

Health-care professionals having the final authority to direct patient care will benefit both patients and insurers in the long run. Patients will be able to seek treatment and fill prescriptions with the confidence of knowing that all the decisions about their medical care are being made with their health in mind, while at the same time allowing insurers to provide oversight that will help prevent medication complications and the overuse of more intensive and expensive care.

This week the American Medical Association will be holding their annual meeting in Chicago. I urge them to listen to the request of Indiana lawmakers and adopt a Health Insurer Code of Conduct. It’s in the best interest of those that matter most — the patients.



Rep. Peggy Welch is a member of the Indiana House of Representatives. She serves as Vice Chair of the House Public Health Committee and is a member of the House Ways and Means Committee. Rep. Welch was instrumental in the passage of HR 91.