Variations in resource utilization among medical specialties and systems of care

As sweeping changes in the organization and delivery of health care are implemented, it is important to examine the relationship between various types of cost-containment efforts, health care costs, and quality of care. This article reviews the evidence that physician specialty training, the organization of physicians, and the method of physician payment are significant influences upon the utilization of health care services. Data from before the late 1980s raised the possibility that family practitioners employed fewer resources than general internists and that health maintenance organizations used fewer resources than solo practitioners. However, the studies from which these data were derived were marred by insufficient attention to patient mix, failure to account for interactions between specialty and system, and inadequate regard for the complexities of modern practice structures. More recent data from the Medical Outcomes Study (MOS) overcomes some but not all of these problems. In general, it can be safely concluded that primary care specialty training, group practice, and prepaid care are associated with less utilization. Nevertheless, much more research is needed to address remaining methodological problems and to obtain data that are generalizable to the wide array of modern practice settings.