Some large Health Maintenance Organizations (HMOs) are taking steps to address problems that have enraged and frustrated their members. Their executives have recognized that it is a lot cheaper and easier to fix mundane service problems than to change the basic rules of managed care.

A recent report by Health Rights Hotline -- a nonprofit assistance program for managed-care consumers in four California counties -- studied the complaints of 2,400 people during the past year.

• Denial of care was the leading complaint -- affecting 17 percent of those surveyed.

• Inappropriate care was cited by 14 percent, as was poor customer service.

• Disputes over payments concerned 11 percent, and 10 percent cited the unmet need for specialty care.

• Other glitches involved delays in getting care and problems with obtaining prescription drugs.

Observers say that HMOs' efforts to streamline the system have involved instituting three-way conference calls between patients, HMO representatives and doctors. Another solution being tried is referring care denials to an outside reviewer for a binding decision. Simply answering phone calls promptly is another policy aimed at reducing patient frustration.

Source: Rhonda L. Rundle, "Under Attack, HMOs Address Patients' Gripes," Wall Street Journal, November 27, 1998.