Utah legislators need to decide whether Intermountain Health Care is a bully or a gentle giant, some of them were told Tuesday.

Dr. Edward F.X. Hughes, a professor of health industry management at the Kellogg School of Management, spoke as part of a series of seminars sponsored by Regence BlueCross BlueShield of Utah, the Salt Lake Area Chamber of Commerce and University of Utah Health Care designed to help Utah legislators and business leaders understand the issues affecting Utah's health care systems.

During this year's general session, the Legislature passed a bill forming a two-year task force to study health care systems in Utah. The task force was created as a result of a debate over IHC's tax-exempt status and its delivery of health care. It will primarily investigate IHC's contracting arrangements in health insurance and health care markets, its tax-exempt status and business and financial practices.

"IHC has been chosen as the No. 1 clinically integrated program in the nation for the last five years," Hughes said.

Hughes said there is a big problem with an organization like IHC being too big. He said that being big is OK, but not when the nature of a company leads to bully-like behavior.

If legislators determine IHC is a gentle giant, that is wonderful, Hughes said. But, if they determine it is more of a bully, then the remedy needs to be specific to the behaviors that are negative.

Hughes said that the Legislature's charge to its 15-member task force that "We need to determine whether health care is a right or a privilege" is "regrettable phraseology."

He told the legislators that two competing values need to be addressed when making health care changes. He said people must look at the battle between equity and efficiency.

"Equity is the attempt by a society to get the maximum amount of the most precious of all social services — medical care — to the maximum number of people," Hughes said.

He said equity is primarily about access. But the other component — efficiency — is equally important. Efficiency involves getting an appropriate amount of medical services to an appropriate amount of people. It includes cost and quality.

In the United States the driving force between quality, cost and access is quality, Hughes said. In the past 50 years the health care industry has progressed dramatically.

"We have radically altered the quality of care being delivered to our citizens, providing a far better, new product," Hughes said.

Hughes said that the United States is unique because what the United States is doing has not been done anywhere.

"A nation's health delivery system is a function of the values of the people of the nation," Hughes said. "That is why we are not like the Canadians. That is why we are not like the British."

"As Utah's health care system experiences growing pains, you have the unique opportunity through this task force to produce a positive outcome," Hughes told legislators. "To be successful, Utah needs a health care market that not only provides quality care at a fair price, but also allows market forces to operate freely to improve the state's overall health."

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