HMOs and utilization of emergency medical services: a metropolitan survey

A survey was conducted of a diverse group of health maintenance organizations (HMOs) serving a large metropolitan area regarding enrollee instructions for use of emergency medical services. Written and verbal requests for written information concerning emergency medical system instructions for enrollees were made to the 25 largest HMOs serving Chicago and surrounding suburbs. Sixteen responses, representing more than 95% of total HMO enrollees, were obtained. Options for access for prehospital care were reviewed and categorized: call 911, call toll-free telephone number, call HMO office or primary physician, go to the nearest HMO-affiliated hospital, and go to the nearest hospital. Of the 16 respondents, 15 HMOs responsible for 99% of the total HMO enrollees advised their subscribers to contact their HMO office or primary physician or to call a toll-free number in the case of an emergency. No HMO advised use of the 911 access as a first response for an emergency. Only two HMO brochures, responsible for 7% of the total HMO enrollees, recommended that 911 access be used. These data suggest that HMO enrollees may not be adequately informed regarding proper use of 911 and the emergency medical services system.