Utilization of hospital services in the Individual Practice Association on Guam: a comparative analysis

The HMO Act of 1973 gives impetus on a nationwide scale to the development of health care delivery systems capable of providing or arranging for comprehensive health services for our nation's consumers. However, while the organizational mode of the group-practice model HMO is well defined and tested, there has not been a similar "track record" established for the individual practice HMO. In this study, the author compares the utilization of hospital beds in two operating programs: an individual practice and a group-practice HMO, serving employees of the Government of Guam, U.S.A. Substantial differences in utilization between the two systems are observed over a 12-month period. With the focus on developing the IPA to meet the objectives for which it is intended, it is suggested that organizational structure, provider incentives, and how utilization controls were employed account for the discrepancy.