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The effect of HMO competition on gatekeeping, usual source of care, and evaluations of physician thoroughness
Andrew R Sommers1, Douglas R Wholey
1Center for Outcome and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, MD, USA. asommers@rti.org
Insights
Health maintenance organization (HMO) competition boosts physician thoroughness for enrollees by increasing usual care sources. For non-enrollees, competition effects on usual care sources offset, yielding no net impact on physician thoroughness.
Area of Science:
- Healthcare Management
- Health Services Research
- Health Economics
Background:
- Health maintenance organizations (HMOs) influence healthcare delivery and patient experiences.
- Understanding the impact of market competition within HMOs on patient care quality is crucial.
- Gatekeeping and having a usual source of care are key factors mediating patient perceptions of physician thoroughness.
Purpose of the Study:
- To analyze how HMO enrollment and competition affect physician thoroughness evaluations.
- To investigate the mediating roles of gatekeeping and usual source of care.
- To determine if HMO competition benefits extend to non-enrollees and if effects differ by enrollment status.
Main Methods:
- Retrospective econometric analysis of nationally representative Community Tracking Study data (1996-1997).
- Regression analyses (ordered logistic, logistic, multivariate) examined relationships between HMO enrollment, competition, gatekeeping, usual source of care, and physician thoroughness.
- Sample comprised 27,441 adults.
Main Results:
- HMO competition increased gatekeeping, which in turn increased having a usual source of care for all individuals.
- For HMO enrollees, competition enhanced having a usual source of care; for non-enrollees, it decreased it.
- Having a usual source of care improved physician thoroughness evaluations for all. Gatekeeping negatively impacted thoroughness evaluations for HMO enrollees.
Conclusions:
- HMO competition ultimately enhances physician thoroughness evaluations for HMO enrollees.
- While HMO competition has spillover effects on non-enrollees, these are counterbalanced, resulting in no net change in physician thoroughness evaluations.
- The study highlights differential impacts of HMO market dynamics based on enrollment status.
Objectives:
To examine the effects of HMO enrollment and HMO competition on evaluations of physician thoroughness through their effects on gatekeeping and having a usual source of care and to determine whether the effects of HMO competition spill over to individuals not enrolled in HMOs and whether these effects differ in those enrolled vs not enrolled in HMOs.
Study Sample:
A nationally representative sample of 27 441 adults from the household component of the Community Tracking Study-Round 1 (July, 1996, through July, 1997).
Study Design:
A retrospective econometric analysis of Community Tracking Study data merged with measures of HMO competition.
Methods:
Gatekeeping was regressed on HMO enrollment, HMO competition, and control variables using ordered logistic regression. Usual source of care was regressed on gatekeeping, HMO enrollment, HMO competition, and control variables using logistic regression. Evaluation of physician thoroughness was regressed on gatekeeping, usual source of care, HMO enrollment, HMO competition, and control variables using multivariate regression.
Results:
HMO competition increases use of gatekeeping and gatekeeping increases having a usual source of care for all individuals. For HMO enrollees, HMO competition increases having a usual source of care, whereas for those not in HMOs, it decreases having a usual source of care. For all individuals, having a usual source of care increases evaluation of physician thoroughness. For those in HMOs, gatekeeping decreases evaluation of physician thoroughness.
Conclusions:
For HMO enrollees, the overall effect of HMO competition is to increase evaluations of physician thoroughness. For those not in HMOs, although there are HMO competition spillover effects, they are offsetting, resulting in no overall effect of HMO competition on evaluations of physician thoroughness.
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