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Neither patient HMO membership nor physician HMO participation is greatly associated with racial disparities in primary care

Neither patient health maintenance organization (HMO) membership nor physician level of HMO participation is substantially associated with racial disparities in primary care, according to a new study. Thus, changes in HMO membership alone are unlikely to affect disparities in receipt of primary care for better or worse, conclude Kevin Fiscella, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry, and Peter Franks, M.D., of the University of California, Davis.

With support from the Agency for Healthcare Research and Quality (HS10910), the researchers used national data on primary care office visits derived from the National Ambulatory Medical Care Surveys for 1985, 1989-1992, and 1997-2000. They determined patient characteristics and HMO membership from reports by primary care physicians and physician HMO participation based on the proportion of the physician's patients who were enrolled in an HMO. After adjustment for other factors affecting receipt of primary care, blacks were less likely than whites to receive a Pap test, a rectal exam, smoking cessation advice, and mental health advice, but were more likely to receive advice on diet and weight and a followup appointment.

There were no significant interactions between receipt of primary care services and either patient HMO membership or physician level of HMO participation, patient race, Medicaid insurance or percentage of Medicaid patients in the physician's practice, or duration of the visit. Previous findings have been mixed regarding the impact of HMOs on racial and ethnic disparities in health care, but prior studies only examined the effect of patient HMO membership on these disparities. This is the first analysis of disparities at the visit level to examine the relationship between physician level of HMO participation and disparities in primary care procedures.

See "Is patient HMO insurance or physician HMO participation related to racial disparities in primary care?" by Drs. Fiscella and Franks, in the June 2005 American Journal of Managed Care 11(6), pp. 397-402.

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