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Mode of payment and identification with a regular doctor. A prospective look at reported use of services
Insights
Health maintenance organizations (HMOs) may lower costs, but continuity of care matters. When patients have a regular doctor, HMO members report higher healthcare utilization for all symptoms, not just acute respiratory issues.
Area of Science:
- Health Services Research
- Health Economics
- Primary Care Medicine
Background:
- Health maintenance organizations (HMOs) are often praised for cost containment.
- A common criticism of HMOs is the potential lack of consistent doctor-patient relationships.
- Physician-patient continuity is a key aspect of healthcare quality and patient experience.
Purpose of the Study:
- To investigate the impact of physician-patient continuity on healthcare utilization within HMOs compared to fee-for-service (FFS) plans.
- To examine differences in reported morbidity between HMO and FFS members.
- To assess how the presence of a regular doctor influences healthcare seeking behavior.
Main Methods:
- A comparative study design was employed, surveying HMO members (N=190) and fee-for-service (FFS) subscribers (N=653) in Los Angeles County.
- Data collection involved assessing the likelihood of identifying with a regular doctor and self-reported physician visit rates for various symptoms.
- Statistical analyses controlled for the presence or absence of a regular doctor to compare utilization and morbidity.
Main Results:
- HMO members were significantly less likely to report having a regular doctor compared to FFS subscribers (P < 0.001).
- Without controlling for regular doctor status, HMO members showed higher visit rates only for acute respiratory problems.
- After accounting for physician-patient continuity, HMO members reported higher utilization for all symptoms (P < 0.05) and digestive issues (P < 0.10).
- Morbidity reports showed few differences, though HMO members reported fewer cold symptoms (P < 0.05).
Conclusions:
- Physician-patient continuity is a critical factor that influences healthcare utilization patterns across different health plans.
- The perceived differences in utilization between HMOs and FFS plans may be partially explained by the varying levels of doctor-patient continuity.
- Future comparisons of health plan performance should carefully consider the role of consistent care relationships.
Abstract:
Despite the apparent success of health maintenance organizations (HMOs) in lowering the costs of health care, they have been criticized for other reasons, including the lack of doctor-patient continuity in the patient's having a regular doctor. Consistent with previous research, HMO members sampled from Los Angeles County (N = 190) were less likely to identify with a regular doctor than comparable fee-for-service (FFS) subscribers (N = 653) (P less than 0.001). When differences in this variable were not controlled statistically, HMO members reported higher rates of physician visits, but only for acute respiratory problems (P less than 0.05). It was not until differences in having a regular doctor were taken into account that HMO members were found to report higher rates of use for all symptoms (P less than 0.05) as well as for digestive problems (P less than 0.10). These findings suggest the importance of taking physician-patient continuity into account when comparing utilization rates across health plans. Additionally, few differences were found in reports of morbidity, although HMO members were less likely to report cold symptoms during this 1-year survey than comparable FFS subscribers (P less than 0.05).