Beyond the Water's Edge: Charting the Course of Managed Care for People with Disabilities - Conference Resource Book. Comparison of Physician and Hospital Use Among People with Chronic Illness in HMO and FFS Plans

11/01/1996

Teresa Fama
Teresa Fama is the Deputy Director of the Robert Wood Johnson Foundation National Program Office, "Chronic Care Initiatives in HMOS." Through this program, Ms. Fama is engaged in fostering and evaluating innovations in the management of people with chronic conditions who are enrolled in HMOS. Prior to her involvement with the Robert Wood Johnson Foundation, Ms. Fama was an analyst at the Prospective Payment Assessment Commission (ProPAC), where she worked on Medicare post-acute care financing issues. Prior to ProPAC, Ms. Fama was a Senior Associate at Lewin-VHI, Inc., a health care consulting firm. Ms. Fama has a Master of Science degree from the University of Rochester in Rochester, NY.

RESEARCH QUESTION

Do chronically ill HMO and FFS enrollees use the same level of physician and hospital services?

DATA SOURCE

1992 National Health Interview Survey

METHODS

Descriptive and multivariate analyses

PRIOR WORK (HEALTH AFFAIRS, SPRING 1995)

  • Refuted the notion that chronic illness is more prevalent among people covered by indemnity plans than by HMOS
  • Could not examine Medicare and Medicaid

CURRENT WORK

Examined two subgroups:

  • People with at least one of 15 chronic conditions
  • People who reported their health as fair or poor

DESCRIPTIVE FINDINGS: MD VISITS

  • HMO enrollees with chronic conditions more likely than FFS enrollees to visit a physician
  • For users, no difference in number of visits

DESCRIPTIVE FINDINGS: HOSPITAL STAYS

  • HMO enrollees with 8+ bed days less likely than FFS enrollees to be hospitalized
  • For users, no difference in average length of stay

REGRESSION RESULTS

  • HMO enrollees with chronic conditions more likely than FFS enrollees to visit a physician
  • For users, no difference in number of visits
  • No difference in likelihood of a hospital stay or, for users, in the average LOS
  • No difference found for subgroup who perceived their health as fair/poor

LIMITATIONS

  • Self-reported data
  • Non-elderly only, with private insurance
  • Can examine utilization only, with some inference about access to care
  • Can't conclude anything about patterns of care or outcomes

POLICY IMPLICATIONS

  • Data indicate that chronically ill have better access to physician care in HMOS than in FFS
  • HMOS appear not to be skimping on care for chronically ill population
  • Question remains: To What Extent are HMOS "Shadow Practicing" the FFS System?
TABLE 1. PHYSICIAN VISITS IN THE PRIOR 12 MONTHS
Variables Percent with 1+ Visits Mean Number of Visits
Indemnity HMO Total Indemnity HMO Total
Has Chronic Condition 85.8% 89.3%* 86.8% 7.6 8.4 7.8
Perceives Health as Fair/Poor 89.0 88.7 88.9 12.2 13.8 12.6
Has Limit in Major Activity 91.5 93.4 92.0 12.2 13.9 12.8
8 or more Bed Days 96.9 98.0 97.2 12.4 13.8 12.9
All Persons 77.3 81.4* 78.6 4.6 4.9 4.7
N (in thousands) = 83,993 38,263 122,256 64,927 31,146 96,073
* Percentage is significantly different at p<.05, compared with indemnity plan.
SOURCE: National Center for Health Statistics, 1992 National Health Interview Survey.

 

TABLE 2. HOSPITAL STAYS IN THE PRIOR 12 MONTHS
Variables Percent with 1+ Visits Mean Number of Visits
Indemnity HMO Total Indemnity HMO Total
Has Chronic Condition 9.7% 8.2% 9.3% 7.6 6.9 7.4
Perceives Health as Fair/Poor 20.0 16.1 18.9 8.6 8.6 8.6
Has Limit in Major Activity 19.1 14.5 17.7 8.8 10.2 9.1
8 or more Bed Days 32.7 26.5* 30.7 8.7 8.6 8.7
All Persons 4.8 4.1* 4.6 5.8 5.7 5.8
N (in thousands) = 83,993 38,263 122,256 4,031 1,561 5,592
* Percentage is significantly different at p<.05, compared with indemnity plan.
SOURCE: National Center for Health Statistics, 1992 National Health Interview Survey.

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