Enrollment Choices in Different Types of HMOs

Berki, S E; Penchansky, Roy; Fortus, Robert S.; Ashcraft, Marine L.

doi:10.1097/00005650-197808000-00005

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…Bice (1975) split risk vulnerability into health and economic risk and found that the effect of health risk on choice of HMOs was valid only under conditions of economic risk. This conclusion was supported by additional studies (Berki, Penchansky, Fortus, & Ashcraft, 1978;Merrill, Jackson, & Reuter, 1985).…”

Section: Health Riskmentioning

confidence: 59%

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Elaborating a Dichotomous Measure of Enrollment Choice

Thomas

2004

Social Work in Health Care

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The objective of this study is to make health insurance plans more responsive to the needs of people by identifying plan characteristics that are important to consumers during their enrollment decisions. Employees from three companies were surveyed. Factor analysis indicated four dimensions of plans that are important to consumers: cost, freedom, quality, and psychosocial access. Among characteristics that described the "cost dimension" of plans, unpredictable out-of-pocket costs was the most important. Among characteristics that described the "freedom" dimension of plans, freedom to go to any doctor without authorization from the primary care physician was most important.

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Section: Health Riskmentioning

confidence: 59%

“…Berki and his colleagues found limited support for the hypothesis. After controlling for the effects of chronic conditions and an individual's relationship with a physician, income showed marginal significance (Berki, Penchansky, Fortus, & Ashcraft, 1978). Other studies provide support for the economic risk hypothesis.…”

Section: Economic Riskmentioning

confidence: 81%

Elaborating a Dichotomous Measure of Enrollment Choice

Thomas

2004

Social Work in Health Care

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“…Compared to fee-for-service enrollers, managed care enrollers have been reported to be less likely to have a personal physician, 8 ' 9 ' 1 ''to have resided in the study area for shorter periods of time 12 and to have lower income, in all studies 5 ' 9 -11-13 but I. 8 No differences in health-related habits, such as smoking, alcohol use, use of seat belts and exercise were noted in 2 studies 1 •" which did not, however, address sex-related behaviours.…”

Section: Discussionmentioning

confidence: 99%

“…3 Thus, understanding the self-selection of enrollers for specific health care delivery systems is becoming increasingly important. Most studies conducted in the United States suggest that MCOs experience a favourable selection of enrollers: persons who choose managed care appear to be less costly to care for than persons who choose fee-for-service coverage/ These conclusions are based on the examination of socio-demographic characteristics, 5 " 1 '' pre-enrolment use of health services, 6 " 11 self-reported indicators of health or disease, 8 " 14 usual source of care, 8 ' 9 ' 1 * health practices, 10 ' 12 ' 15 ' 16 health concerns 8 ' 14 and subsequent mortality. 1 ^ The utility of published results regarding selfselection is limited by the fact that only 1 cultural context has been studied (United States) and that most studies include only few explanatory variables.…”

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confidence: 99%

Self-selection of enrollers at the creation of a managed care organization

Etter¹,

Perneger²,

Rougemont³

1995

Eur J Public Health

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Factors affecting choice between a managed care organization (MCO) and a fee-for-service insurance plan were examined when the University of Geneva health Insurance plan was transformed into an MCO, in October 1992. A case-control study using a mailed questionnaire (response rate 84%) was conducted to compare former members who joined the MCO (joiners, n=421) to former members who opted out in order to keep fee-for-service coverage (non-joiners, n=222). Non-joiners were more likely to be women (odds ratio (OR) from multivariate model was 1.15, p=0.50], to be bom in Switzerland (0R=2.04, p<0.01), to have an annual income >75,000 Swiss francs (0R=2.00, p<0.01), to have a personal physician (0R=1.96, p<0.01) and to have consulted a specialist (OR=1.69, p=0.02) or used unconventional medidne (0R=4.59, p<0.01) in the past year. During the previous year, non-joiners had more hearth care visits than joiners (14.6 versus 9.1, p=0.01). Non-joiners reported better mental health and fewer complained of persistent fatigue (OR=2.18, p=0.03). The choice of hearth plan was strongly influenced by socio-demographic characteristics, past patterns of hearth services utilization and health status. The self-selection process was paradoxical: MCO joiners had used fewer hearth care visits than non-joiners, but their self-reported hearth status was worse. The differences we have observed between self-selected populations have important implications for the financial performance of competing health care delivery systems. Key words: managed care organizations, selection process, health status, health services utilizationManaged care is becoming increasingly popular. In the United States, enrolment in managed care organizations (MCOs) has grown rapidly over the past few decades 1 and similar organizations have been recently created in Europe, 2 including Switzerland. As a consequence, the health care consumer is now faced with a greater diversity in health care delivery systems. Both managed care and competition between delivery systems are expected to improve the efficiency of the health care sector. However, some health care plans may be able to attract healthier members than others. Such selection may provide a substantial competitive advantage, over and beyond that derived from improved efficiency of health care. 3 Thus, understanding the self-selection of enrollers for specific health care delivery systems is becoming increasingly important. Most studies conducted in the United States suggest that MCOs experience a favourable selection of enrollers: persons who choose managed care appear to be less costly to care for than persons who choose fee-for-service coverage/ These conclusions are based on the examination of socio-demographic characteristics, 5 " 1 '' pre-enrolment * if. Etter, T

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“…Studies which relate aspects of the physician-patient relationship to a variety of areas of performance indude: (1) the amount of use (Aday 1975(Aday , 1976; Andersen and Aday 1978; Berki and Ashcraft 1979;Berki et al 1978; Colle and Grossman 1978; (or managing physician) in controlling utilization and costs in Medicaid programs and IPA-model HMOs and to integration of a capitated form of payment with the managing physician supports the view that this is an important area of study.…”

Section: Importance To Health System Performancementioning

confidence: 99%

Patient-Provider Concordance: A Review and Conceptualization

Penchansky

1986

Medical Care Review

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The existence and character of the relationship between a patient and provider are probably key variables determining the performance of the medical care system. Prior analyses of this relationship have addressed it as three largely distinct areas: the patient having a usual source, a personal physician, or a central source; the concept of managing physician, primary physician or gatekeeper; and,-the patientphysician interpersonal or therapeutic relationship.If the relationship between provider and patient is important, then there is a need to answer the questions: Are there factors that influence the existence or strength of the relationship and, if so, what are they? How do the existence and strength of the relationship influence choice of source, use, quality, compliance, efficiency, and satisfaction? Will the addition of a measure (or measures) of the existence and characteristics of the patient-provider relationship improve our ability to explain the functioning of the health 'care system? How can the relationship between patient and system or provider be characterized in ways useful for research and policy analysis? This article has four major objectives: to establish the importance of usual source (personal physician or managing physician) to health at UQ Library on June 18, 2015 mcr.sagepub.com Downloaded from

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Enrollment Choices in Different Types of HMOs

Cited by 14 publications

References 9 publications

Elaborating a Dichotomous Measure of Enrollment Choice

Elaborating a Dichotomous Measure of Enrollment Choice

Self-selection of enrollers at the creation of a managed care organization

Patient-Provider Concordance: A Review and Conceptualization

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