Research article summary (published 29 Apr 2002):

Personal choices of health plans by managed care experts.

Full Abstract

BACKGROUND:
Expert opinion has not been used as a basis for comparing different forms of health insurance, in part because this perspective may not be appropriately sensitive to aspects of care that consumers value.

RESEARCH DESIGN:
Using a case-control design, managed care experts were surveyed at 17 academic institutions in the United States to determine the type of health plan they chose (fee-for-service, HMO, POS, PPO, or catastrophic). Controls consisted of academicians from other disciplines at these institutions who ostensibly faced the same insurance options. We then compared the choices of physician experts, nonphysician experts and controls using a multinomial logit model that was sensitive to the choice set available at each institution. We also examined the choice behavior of respondents within moderate (< $150,000) and high (> or =$150,000) income levels.

RESULTS:
Four hundred thirty-seven experts and 465 controls were surveyed and responses were received from 73.7% and 52.7%, respectively. Physician experts were approximately half as likely (14.9%) as controls (26.6%) or nonphysician experts (27.6%) to enroll in HMO plans. In moderate-income households, both physicians (Relative Risk [RR] = 0.42; P <0.01) and nonphysician experts (RR = 0.71; P <0.1) were less likely than controls to opt for an HMO. Experts' propensity to choose HMO coverage varied little with income, whereas controls' propensity changed dramatically between moderate (39.1% in HMOs) and high (14.0% in HMOs) income categories.

CONCLUSIONS:
The aversion of physician experts, and nonphysician experts with moderate income, to HMO plans may be caused by their stronger distaste for the constraints on choice and access that typically accompany HMO coverage. Alternatively, it may be explained by their superior ability to absorb, understand, and use information about available insurance options. Insights into quality in managed care may also play a role.

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Author information

Author/s: Studdert, David M (DM); Bhattacharya, Jayanta (J); Schoenbaum, Michael (M); Warren, Brandee (B); Escarce, José J (JJ);

Affiliation: Harvard School of Public Health, Boston, Massachusetts, USA. studdert(-atsign-)hsph.harvard.edu

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: Medical care (Med Care), published in United States. (Language: eng)

Reference: 2002-May; vol 40 (issue 5) : pp 375-86

Dates: Created 2002/04/18; Completed 2002/06/21; Revised 2006/11/15;

PMID: 11961472, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult Attitude of Health Personnel Attitude to Health Case-Control Studies Choice Behavior Faculty Fee-for-Service Plans - standards Female Health Care Surveys Health Maintenance Organizations - standards Health Services Accessibility - standards Humans Income - statistics & numerical data

Insurance, Major Medical - standards Logistic Models Male Managed Care Programs - classification; standards Middle Aged Physicians - psychology Predictive Value of Tests Preferred Provider Organizations - standards Quality of Health Care Questionnaires Sensitivity and Specificity United States Universities

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