Community characteristics as predictors of perceived HMO quality

We model the impact of community characteristics on people's perceptions of the quality of their health care experiences in HMOs. We focus on three community characteristics: sense of community, population density, and population diversity. Sense of community refers to people's perception of interconnection, shared responsibility, and common goals. Population density and population diversity are community characteristics that affect transactions costs in terms of time and energy, and affect people's perceptions of their community. We use data from a 1993 Florida poll to estimate the relationship between HMO members' perceptions of problems with health care experiences (cost, choice, access, satisfaction) and community characteristics. We find that all three community variables are significantly associated with perceptions of health care problems. We also find that effects of community variables operate differently for those in HMOs vs. those under traditional insurance. This study is consistent with research showing that community characteristics impact the health status of community institutions. Results suggest that providers may be able to improve care by being more responsive to individuals' need for community, that providers and communities can mutually gain by collaborating to improve community health, and that it may be cost-beneficial to factor community issues more strongly into health care policy.