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Master's Professional Reports Abstract

The Impact of HMO Consumer Complaints on The Texas HMO Regulatory Environment

The rapid growth of managed care organizations in Texas in recent years has forced many operational and regulatory issues to the forefront of public policy debate, placing the burden on both regulators and state policy makers to develop constructive solutions. Consumer complaints have also increased, particularly those pertaining to quality of care provided by Health Maintenance Organizations. The Texas Department of Insurance is responsible for investigating and resolving these complaints. This paper explores the policy issues surrounding quality of care provided by HMOs, TDIs effectiveness in investigating and resolving consumer complaints, and TDIs ability to use the complaints they investigate and track to effect legislation. This paper also looks at the difficulties TDI faces in HMO regulation, evaluates how TDI faces these difficulties and makes suggestions for the future.

-- Author's foreword.