Do HMOs Make a Difference?

Comparing Access, Service Use and Satisfaction Between Consumers in HMOs and Non-HMOs

Conference Transcript
March 9, 2000

Roundtable Participants

Linda Bilheimer, Ph.D.
Senior Program Officer
The Robert Wood Johnson Foundation

Janet Corrigan, Ph.D.
Director, Health Care Services Division
Institute of Medicine

Robert Reischauer, Ph.D.
President
Urban Institute

John Rother
Director of Legislation and Public Policy
AARP

Other Participants

Paul Ginsburg, Ph.D.
President and Discussion Moderator, Center for Studying Health System Change

Peter Kemper, Ph.D.
Vice President and Study Co-Author, Center for Studying Health System Change

James Reschovsky, Ph.D.
Senior Health Researcher and Study Co-Author, Center for Studying
Health System Change

ealth maintenance organizations (HMOs) are largely seen by the public as offering lower quality of care than other types of health insurance, principally due to concerns about constrained provider choice, reduction in access to services and other factors. These concerns have contributed to the managed care backlash and calls for patients’ rights legislation.

To provide context for policy discussions about the future of HMOs, the Center for Studying Health System Change (HSC) recently completed comprehensive research on 35,000 privately insured individuals, comparing those in HMOs with those in other kinds of plans. The results suggest that although reliance on specialists and types of access problems differ between HMOs and other plans, overall access to services does not. Despite this, consumers continue to perceive HMOs as offering somewhat lower-quality care.

Some results highlight well-known differences between how care is delivered in HMOs and other plans. However, other results suggest that conventional wisdom about how care is delivered in these different types of plans may be unfounded.

HSC researchers will begin the conference by presenting their nationally representative findings. A roundtable of experts comprising a who’s who of health care policy makers will then discuss the policy ramifications of the study’s conclusions. The exchange will focus on the facts and fiction surrounding HMOs, as informed by the study results and other research. Panelists will grapple with issues raised by the study, including:

• Consumers pay lower out-of-pocket costs in HMOs, but lose some control over the care they receive. Are consumers willing to make this trade-off? What explains the seeming inconsistencies between how HMOs and other types of health insurance compare on objective measures and differences in consumer assessments?
• Is patient’s rights legislation necessary to address perceived access problems in HMOs? Are HMOs managing care so aggressively that patients now face undue barriers to the care they need, or have HMOs found the right balance between primary/preventive care and more costly specialty care?
• What is the future of the HMO model? Will consumer and purchaser pressures lead to new forms of managed care, making HMOs an anachronism? How will patient’s rights legislation, if enacted, affect the industry and the consumer?

Following the roundtable’s reactions to the research findings and debate of issues raised by the results, the discussion will be opened to the audience for an extensive question-and-answer period. Conference attendees will have an opportunity to ask the study co-authors about their findings and pose additional questions to the roundtable participants. Attendees will also receive the first copy of this research, which is being published in six separate papers in the winter issue of Inquiry.

Who Should Attend:

Policy makers

Industry leaders

Advocates