Feature Story

Patients prefer to receive care from doctors who see people from several health plans

Patients are more satisfied with their primary care and are more trusting of doctors who are not restricted to treating only members of a single health plan, according to a new study published in the Archives of Internal Medicine and funded by the Agency for Healthcare Research and Quality.

The findings are derived from a study of 6,000 Massachusetts State government employees by a team of researchers led by Dana Gelb Safran, Sc.D., Director of the Health Institute of the New England Medical Center in Boston. The State employees, who belonged to different types of health plans, were asked to rank the performance of their physicians according to 10 categories of health care quality, such as access to care, continuity of care, doctors' knowledge of their health, and how well their physicians communicated with them.

Patients of "staff model" HMOs ranked their physicians the lowest in 9 of the 10 categories. Staff model HMOs are health plans that employ salaried physicians to treat their plan members only. The only category in which these plans didn't score at the bottom was preventive health counseling.

"Group-model" HMOs performed at intermediate levels. These HMOs resemble staff model-HMOs in that they restrict doctors to serving only their patients but differ in how they pay the doctors. Group-model HMOs performed better than staff-model HMOs in all 10 aspects of quality model health plans.

The most favorably rated plans were the open-model ones, which allow patients to see doctors who work in different locations and do not restrict physicians to treating patients in only one insurance plan. Open-model plans include managed indemnity insurance (traditional fee-for-service insurance with controls such as preauthorization for hospital admission), point-of-service plans, and network-model HMOs.

For most aspects of care, patients reported no differences in the quality of care received under the various open-model forms of health insurance. Point-of-service plans contract with networks of physicians on a nonexclusive basis and allow their enrollees to obtain care from non-network doctors if they are willing to pay more out-of-pocket. Network-model HMOs also contract with networks of physicians on a nonexclusive basis, but they do not cover care provided by doctors who are not in their networks.

Details are in "Organizational and financial characteristics of health plans: Are they related to primary care performance?" by Dr. Safran, William H. Rogers, Ph.D., Alvin R. Tarlov, M.D., and others, in the January 1, 2000, Archives of Internal Medicine 160, pp. 69-76.

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