Sunday’s column by Dr. Esther Smith (no relation) makes clear that, unchecked over time, the obstacles placed between the patient and physician will continue to grow in number and complexity (“New lab-test authorization is harmful,” Star-Advertiser, Island Voices, July 14).

HMSA and its relationship with Avalon is a small piece of the ever-increasing presence of venture capital and investment firms controlling the operations and finances of an increasingly larger part of our fragmented medical system.

In reviewing the Avalon website, one can readily see that the leadership of Avalon is filled with many individuals with careers in venture capital and investments, many outside of healthcare. With these people so far removed from patient care now controlling healthcare services, hospital systems and physician groups, we can only expect more decisions to be made on financial results and not healthcare outcomes.

Dan Smith

Hawaii Kai

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