To the Academic Senate, Santa Cruz Division:

The Committee on Faculty Welfare (CFW) dealt with various issues this year, although the committee decided that its primary concern would be child care.

There were various meetings during the year, including one with Chancellor Greenwood. One of CFW's goals was to assure that the Child Development Facility that has been planned for over a decade be made a funding priority for the campus. This was accomplished in May with the help of the Director of Child Care Services Lise Bixler, Director of Development Nancy Loshkajian, Vice Chancellor Francisco Hernandez, and a petition signed by half of the UCSC faculty. CFW also requested that more space be made available for child care and that alternative funding strategies be developed. UCSC is the only campus in the UC system that has a policy of funding child care facilities exclusively through gift funds. Finally, because the Millennium Committee placed the responsibility for implementing its recommendations concerning child care in the Office of the Chancellor and Executive Vice Chancellor, CFW has asked the Chancellor to be more proactive in the child care area and to set up a Child Care Task Force and/or give someone in her office direct responsibility for seeing that child care receives the priority it deserves.

Appended is a report on the CFW survey of the faculty concerning health care. The main conclusion of the survey is that there is a need for an alternative medical care provider to the Santa Cruz Medical Clinic. CFW determined that UCSF/Stanford is interested in setting up a satellite clinic in the Santa Cruz area. Besides providing an option to the Santa Cruz Medical Clinic, such a clinic would presumably allow referrals to specialists in the UCSF and Stanford Hospitals. This is something strongly desired by the faculty. CFW strongly encourages the administration to do everything in its power to support the establishment of a UCSF/Stanford satellite clinic.

The CFW went on record endorsing the principles set forth by the UC-wide Academic Council on March 13, 1991 in a document entitled: "Operating Principles Applicable to Parking Policy." Specifically, this document calls for reimbursement to TAPS for parking spaces lost to new construction and forbids the use of interest from parking revenues for the Chancellor’s Discretionary Fund. Currently, this campus does not reimburse TAPS for parking spaces lost to new construction and interest from parking revenues goes into the Chancellor’s Discretionary Fund.

The CFW also discussed a number of other issues, including spousal support, copyright policy, and faculty housing.

June 3, 1999

Appendix.

In the Fall Quarter, 1998, the Committee on Faculty Welfare asked members of the Academic Senate to fill out a survey concerning their perception of the adequacy of the University’s Health Care program. About 525 surveys were distributed and 151 were returned (a 29 percent return rate). The Committee recognizes the potential bias in this sample, as it seems likely that those with more negative experiences would tend to complete and return a survey of this nature. We will return to this point in our concluding comments.

There were 50 women respondents and 101 men. The mean age for the women was 47.88 and for men 54.07. Thirty-one of the men were over 60 but only 4 of the women. Table 1 shows the medical insurance plans selected by our men and women respondents.

Table 1. Number of Respondents Choosing Each Medical Plan

The questionnaire was kept deliberately short. Respondents were asked their gender, age, and medical insurance plan. There were four questions to be rated on a 5-point scale, ranging from Not Satisfied (1) to Somewhat Satisfied (3), to Very Satisfied (5).

The questions were:

"How happy are you with your health insurance plan? IF NOT happy, why not?"

"How happy are you with your primary care physician? IF NOT happy, why not?"

"Do you feel you have adequate access to specialists? IF NO, tell us about

your experience."

"Would you like more choices in health care? IF NOT satisfied, describe what

choices you would like."

After each question there was space for the respondent to write more. Finally, there was the item:

"Please write additional comments in this space."

The respondents were slightly more happy than not with their plan (the mean for the entire sample was 3.55). Men reported being more happy with their plan (mean of 3.65) than did women (mean of 3.36), but these differences were not statistically significant. There were statistical differences between the plans, however. Table 2 shows the mean ratings for each of the plans.

Table 2. Mean Ratings for Happiness with Plan (5 is most positive)

Statistical analyses indicated that the respondents who had Prudential High were significantly happier with their plan than were those with HMOs (Health Net or Pacificare) or with UC Care. Other differences in ratings between plans were not significant. It should be noted that, with one exception, all respondents with Prudential High were over 65--that is, this program is usually a supplement to Medicare. Eighty-nine percent of the respondents under the age of 65 were with HMO plans.

Respondents who were not satisfied with their plan cited a number of reasons. HMOs were criticized for difficulties concerning coverage for physical therapy and for outpatient therapy generally. There were also complaint about slowness in paying bills for emergency treatments outside the Santa Cruz area. Quite a few respondents complained about out-of-date prescription drug formularies. There were several complaints about the declining quality of care. One respondent wrote as follows of her experiences with Pacificare:

HMOs were also criticized for cost-saving measures. One respondent wrote:

There were a number of complaints about UC Care. There was concern about the short list and variable quality of physicians available locally through UC Care. One respondent wrote that she had tried to switch to UC Care and called every doctor on the list; only one was accepting new patients. Several respondents complained about billing procedures with UC Care. One wrote:

Respondents were generally at the high (positive) end of the scale on this item (the overall mean was 4.22). There was a general expression of satisfaction with one’s personal care physician by both men and women. The 33 respondents over the age of 60 were significantly more satisfied than those below 60 (means of 4.52 and 4.13, respectively).

There were also differences between respondents according to health plan (Table 3).

Table 3. Mean Ratings for Happiness with Primary Care Physician (5 is most positive)

Statistical analyses indicated that the respondents who had Kaiser and UC Care were significantly less happy with their primary care physician than were those in other plans.

A number of respondents mentioned difficulties making timely appointments with their primary care physician. Quite a few felt their routine visits were rushed. Several mentioned that the Santa Cruz Medical Clinic was overloaded and too busy.

Ratings were considerably lower for this item. The mean for all respondents was 3.58 on a 5-point scale. Women were less satisfied with access to specialists than were men (means of 3.29 and 3.72, respectively), but these differences were not significant statistically. Again, a major factor was insurance plan (Table 4). Those in Prudential High

Table 4. Mean Ratings for Access to Specialists (5 is most positive)

scored significantly higher than those in other groups. There were no statistically significant differences between the other groups.

There were numerous complaints about the lack of access to specialists. A number in HMO plans noted that their primary care physician was reluctant to refer them to specialists in spite of obvious problems requiring specialist’s care. Several respondents complained of the time it takes to get an appointment with a specialist once a referral is approved. In one case a two-month period elapsed before a back pain was correctly diagnosed as cancer. Another respondent wrote:

HMO plan members complained of not being able to pick a specialist from Stanford/UCSF.

The overall mean on this item was 3.29, indicating that respondents were "somewhat satisfied" with their health care choices. Again, women were less satisfied than men on this item (3.04 to 3.38, respectively), but again these differences were not statistically significant. Insurance plan was again a major factor (Table 5). Those in Prudential high were significantly more satisfied than those in HMOs or UC Care. The differences for Kaiser were not statistically significant because there were only two people in that plan who answered this question.

Table 5. Mean Ratings for Satisfaction with Choices (5 is most positive)

Quite a few respondents noted that the number of choices was inadequate. One respondent suggested that UC Care, Tier 1, allow for access to UCSF and Stanford.

One particular complaint was that there was not a fee-for-service plan with reasonable rates. The Prudential High option for those not on medicare was viewed as outrageously expensive. There were requests for an HMO plan that would cover such alternatives as traditional Chinese medicine, biofeedback, homeopathy, naturopathy, and chiropractice.

There were also complaints about coverage for substance abuse problems.

A number of respondents also noted that coverage of mental health services by HMOs is severely limited in terms of choice of therapist, number of sessions, and ease of authorization. Several mentioned that they experienced considerable job stress but that their medical plans limited payment for therapy and that they ended up paying out-of-pocket.

Quite a few respondents indicated that they had required very little by way of health care service and so had not really tested the system. Some noted that they had heard of horror stories from others with serious health problems. One respondent wrote:

One issue that was raised was the problem of non-emergency coverage when out of the area. For the 90 percent of respondents under 65 on HMO plans there is no coverage when out of town or out of the country, except for emergency treatments. Respondents in UC Care complained about problems getting bills paid at all or in a timely manner.

Requests for coverage for alternative medicine were mentioned by a number of respondents. One respondent noted that Santa Cruz is a key area for alternative and complementary medicine. She felt that the University should become known for its pathbreaking collaborative efforts with local healers.

Respondents over 65 generally chose the Prudential High Option. There was generally a high degrees of satisfaction with this plan. One 75 year old respondent wrote:

Eighty-nine percent of the respondents under 65 were members of HMOs. All of these HMO members use the Santa Cruz Medical Clinic as their medical group (as do most of the respondents over 65). Indeed, it is not an exaggeration to say that the SCMC has a near monopoly on health care for the UCSC faculty (and staff). This lack of choice is unique to Santa Cruz among the UC campuses.

Faculty and staff are at the mercy of the SCMC, which has refused to provide medigap coverage for members over 65 and whose primary care physicians are overloaded (hence the long wait times for appointments our respondents complained about). The SCMC is also unwilling to contract with UC Care--something that is commonly done by other medical groups. Presently, UC Care does not provide a viable option for many faculty and staff because there are so few doctors available in this area who are outside of SCMC and are willing to take on new patients.

It has come to our attention that the UCSF/Stanford Medical Group would like to set up a satellite clinic in the Santa Cruz area. Such an option would be extremely desirable for many of the staff and faculty. Besides providing an alternative to the SCMC, some competition might serve to improve services at SCMC. Furthermore, a UCSF/Stanford satellite clinic would presumably satisfy one of the most important desires of many of our respondents--access to the specialists of these University hospitals.

Every effort be made to increase the choices available to faculty and staff for health care providers in addition to the Santa Cruz Medical Clinic. Specifically, the UCSC administration and the UC President’s Office should do everything in their power to support the UCSF/Stanford Medical Group’s efforts to set up a satellite clinic in Santa Cruz.

The concern about lack of access to specialists occurred repeatedly. There were complaints about not being able to get second opinions from other than SCMC doctors. There were complaints about lack of coverage for alternative and complementary medicine. Some respondents complained about limits to coverage for psychological and substance abuse therapy. Other complaints were about how bills were paid (or not), about drug formularies, and about the declining quality of medical care generally.

It may be impossible to satisfy all of these wishes, but the university should take every step possible to deal with legitimate complaints and to assure that the quality of care is consistently high.

UC should put greater pressure on medical care providers to meet the performance standards agreed to in contracts.

The respondents most satisfied with their health care coverage are those over 65 who have the Prudential High Option in addition to Medicare. This is a relatively expensive, but affordable plan. However, there is the danger that future costs will rise above what is affordable to those over 65.

The university should do everything in its power to assure an affordable program, such as the Prudential High Option, be available to those over 65 who have Medicare.

In conclusion, it should be noted that this report is based on the responses of only about 30 percent of those sent the health care survey. The respondents might be expected to be more dissatisfied than the average faculty person. Generally, however, there was a fairly high level of satisfaction--especially with one’s primary care physician. We suspect that the concerns expressed by our respondents are widely shared and we hope that those responsible will do what they can to implement our recommendations.