The proposed patients' bill of rights: the case of the missing equal protection clause.

Following the footsteps of most other states, Massachusetts opened its Office of Patient Protection in January 2001. Established under what the media hailed as a “landmark” patients’ bill of rights, the Massachusetts legislature created a state agency empowered to review medical decisions made by health maintenance organizations (HMOs) that are challenged by patients. However, after opening its doors, the agency now faces an immediate and major problem—the lack of any patient complaints. On January 27, 2001, the Boston Globe reported the agency’s activity as follows: “[I]n their first three weeks, the medical crusaders in this little office have been more like those proverbial Maytag repairmen—twiddling their thumbs in boredom. The office, established under a landmark patients’ bill of rights as a referee between HMOs and clients, has yet to hear a single beef.” While the problem may be due to a lack of knowledge about the availability of the appeals process, the immediate result of this Massachusetts reform mirrors the longer-term experience of other states. Health policy researchers at Georgetown University analyzed the limited reliance of patients on the right to appeal HMO decisions and found that patients rarely exercise their newly found due process rights to appeal treatment denials. For example, in the first five years of Florida’s external review process (from 1993 to 1998), only 403 cases arose in a population of 4.4 million state residents enrolled in managed care plans. Despite the relatively small impact of this health care reform effort by various states, it appears that Congress will soon pass similar “landmark” federal legislation. In the past year, the presidential candidates and the U.S. Congress