Health status and health care use by type of private health coverage

Area of Science:

• Health Services Research
• Healthcare Policy
• Epidemiology

Background:

• Lower hospital utilization rates are frequently observed among members of health maintenance organizations (HMOs) compared to individuals with other health insurance.
• Common explanations for this discrepancy include self-selection of healthier individuals into HMOs or incomplete recording of hospital use.

Purpose of the Study:

• To investigate the validity of common assertions regarding lower hospital use among HMO members.
• To examine the actual health status and hospital utilization patterns of a representative sample of individuals covered by different healthcare arrangements.

Main Methods:

• A major study was conducted in California.
• A representative sample of individuals under age 65 was selected.
• Data on health status and hospital use were collected and analyzed.

Main Results:

• The study found that assertions of self-selected healthier populations in HMOs were unfounded.
• Evidence did not support claims of underreported hospital use among HMO members.
• Actual hospital use rates were analyzed for a representative sample.

Conclusions:

• The frequently observed lower rates of hospital use by HMO members are not attributable to a healthier enrollee population.
• Incomplete recording of hospital use does not explain the lower utilization rates in HMOs.
• Further research may be needed to understand the factors influencing differential healthcare utilization.