Competition is good. In retailing, the airline industry, restaurants and any other business, a greater number of choices usually leads to lower prices and improved services for consumers.

Competition is also good in the medical field, as The Advertiser correctly pointed out in an editorial on Tuesday ("Avoid disruptions in QUEST healthcare").

The editorial was off the mark, however, in speculating that an initiative to increase competition among health plans could negatively affect patients covered by QUEST, a Medicaid program administered by the state Department of Human Services. QUEST provides free or minimal-cost healthcare coverage for approximately 165,000 low-income adults and their children in Hawai'i.

As director of the department, I know that when health plans face stiffer competition, they do more to attract patients, such as offering extra services and incentives to stop smoking, increase physical fitness, improve eating habits and get immunizations and specialized exams for children.

From 2000 to 2002, however, our QUEST recipients saw their choices reduced by half when three of the six health plans pulled out of the program. Since then, the remaining three plans have retained their market shares, so competition has virtually come to a standstill.

The Department of Human Services wants to change that by inviting additional health plans to bid for Medicaid contracts. At the same time, we want to level the playing field by making sure that the current plans do not have an unfair advantage over any newcomers.

The best way to accomplish this, marketing experts tell us, is requiring our clients to actively choose their healthcare plans through "positive enrollment." This process is a good idea because it treats our clients with dignity by empowering them to make meaningful choices about their healthcare needs.

When the department offered positive enrollment on past occasions, a stunning 95 percent of our clients selected their plan. Only 5 percent who did not make a choice were automatically assigned a plan, from which they could easily opt out.

People with a financial stake in maintaining the status quo may argue that positive enrollment has the potential to disrupt medical treatment and break up longstanding doctor-patient relationships. That is simply untrue.

The department has developed a wide safety net that will enable our QUEST clients to switch healthcare plans as often as they wish within a 150-day period, or change plans at any time if there is cause to do so. Also, in the majority of cases, changing plans would not mean changing doctors and disrupting continuity of care, because the majority of Hawai'i physicians participate in multiple plans.

Additionally, if a client is auto-assigned to a new plan and shows up by mistake for a visit at their previous plan's doctor, there will be no disruption in receiving medical services, even if that physician is not in the new plan.

For example, let's say a homeless, pregnant woman was not aware of the positive enrollment program and was auto-assigned to a new healthcare plan with a different prenatal doctor. If she comes to see her previous plan's doctor by mistake, no worry. Because of the expanded safety net, she will be treated by that doctor at that time and the Department of Human Services will pay the bill.

Moreover, the woman will have the opportunity during that visit to immediately opt out of the auto-assigned healthcare plan and back into her previous plan, or into another plan of her choosing.

People who favor the status quo may also argue that positive enrollment is a negative, saying that QUEST clients are often incapable of making informed decisions about competing healthcare plans. Such a claim is false and demeaning.

When presented with the option of choosing a plan or having one auto-assigned, department clients overwhelmingly have demonstrated, time and time again, that they are perfectly capable of picking the healthcare options that are best for them.

Contrast that scenario with the present situation. QUEST clients have the opportunity to change healthcare plans, but the lack of meaningful alternatives causes almost all of them to remain in their current plans. This is not so much choosing to stay as it is an absence of options.

By increasing competition among plans, Human Services will promote better care for our clients and better use of taxpayer dollars. Also, the expected cost savings will enable the department to stretch its QUEST budget to cover additional needy children and adults. In this regard, it is important to understand that the Department of Human Services will not award a contract to any plan that underprices its services.

To inform our clients about the available healthcare plans and to enroll up to 20,000 more uninsured adults and 9,000 children in QUEST, the department will join with community groups to conduct a statewide public awareness campaign. In addition, the positive enrollment form will include information in 15 locally spoken languages about where to call for translation services.

This outreach will be conducted as part of our larger effort to spread the word about significant changes in Medicaid law enacted by Congress this year as part of the Deficit Reduction Act. Under this act, Medicaid recipients must show proof of U.S. citizenship and fulfill other requirements to continue receiving aid.

We're working hard to make sure all our clients meet the new federal requirements and keep their healthcare coverage. This far greater issue should be everyone's primary focus, not protecting the market share of current healthcare plans.

Clearly, increased competition among health plans is good for QUEST recipients and for Hawai'i taxpayers. We look forward to making this happen.