Physicians Who Are Experts On Managed Care Avoid Enrolling In HMOs When Selecting A Personal Health Insurance Plan
For immediate release: April 29, 2002
Boston, MA — In the first study to examine the personal health insurance choices made by scholars who study managed care, researchers from the Harvard School of Public Health and RAND found that physician experts shy away from health maintenance organizations (HMOs) when choosing a health plan for themselves and their families. The study findings appear in the April 29 issue of the journal Medical Care.
The researchers surveyed 279 professors at 17 universities across the country who were prominent experts in managed care. They also surveyed “controls,” consisting of other professors at the same institutions who did not study health care but had the same health plan choices available to them. Comparisons of these two groups showed that the experts who were physicians were almost half as likely to choose an HMO plan. Instead, the physician experts were attracted to fee-for-service and point-of-service options—the kinds of plans that have fewer restrictions on access to services and choice of physician.
In addition, physician experts, regardless of income level and non-physician experts with income above $150,000 were less likely than their matched counterpart to choose an HMO plan. The likelihood of choosing an HMO among the non-experts changed dramatically between those with moderate income levels (39.1 percent enrolled in HMOs) and those with high income levels (14 percent enrolled in HMOs).
“It is not clear why physician experts tend to steer away from HMOs,” said David Studdert, lead author of the study, and assistant professor of health policy and law in the Department of Health Policy and Management at the Harvard School of Public Health. “These doctors may have stronger distaste for the constraints that HMOs impose. Through their work, they may have preferences for specific providers and facilities that are not part of the HMO network on offer. However, one cannot rule out the possibility that the experts’ choices stem from special insights into managed care that non-experts don’t have.”
The study also found that experts who were not physicians made similar choices to non-experts overall. But when participants with high income were excluded from the comparison the experts were again less likely to choose HMO coverage.
Studdert said, “What is clear from our results is that it’s the physicians, the people who are closest to the bedside and who almost certainly have the most direct experience with managed care, who were the least likely to choose HMOs.”
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