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Patients Like Care Better from Doctors Not Limited to a Single Health Plan

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Research Alert Date: January 10, 2000

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 in today's Archives of Internal Medicine that was funded by the U.S. Agency for Healthcare Research and Quality (AHRQ).

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

"Group-model" HMOs, which resemble staff model-HMOs in that they restrict doctors to serving only their patients, but differ in how they pay them, performed at intermediate levels. Group-model HMOs performed better than staff-model HMOs in all 10 aspects of quality, but not as favorably as open-model health plans.

The most favorably rated plans were the open-model ones, which allow the use of doctors who work in different locations and who are not restricted to treating patients in only one insurance plan. Open-model plans include managed indemnity insurance—traditional fee-for service insurance with controls such as pre-authorization 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 non-exclusive basis and allow their enrollees to obtain care from non-network doctors as well, if they are willing to pay more out-of-pocket. Network model-HMOs also contract with networks of physicians on a non-exclusive basis, but do not cover care provided by doctors who are not in their networks.

Details are in "Organization 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.

Note to Editors:

  • For further details or interviews of Dr. Safran, contact Melissa McPherson, New England Medical Center, (617) 636-0200.
  • On December 6, 1999, the Agency for Health Care Policy and Research was renamed the Agency for Healthcare Research and Quality under P.L.106-129. The Agency, a part of the U.S. Department of Health and Human Services, is leading Federal research efforts to improve the quality of health care, reduce its cost, improve patient safety, address medical errors, and broaden access to essential services.

For more information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Migdail, (301) 427-1855 (

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