The Rand Health Insurance Experiment and HMOs.
The Rand Health Insurance Experiment (HIE) provides the most persuasive evidence to date on the relative effects of health maintenance organization (HMO) and fee-for-service care on utilization, costs, client satisfaction, and health care outcomes. Publications from the HIE have suggested that HMO care was associated with lower costs because of reduced hospitalizations, lower client satisfaction, and poorer health status among the subgroup with limited incomes and initial health status. In our view, the evidence justifies the conclusions related to utilization, costs, and satisfaction, but not the suggestion that HMO care had adverse health effects on low-income, sick individuals.
Wagner
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Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98112.
Bledsoe
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D000328:Adult; D003258:Consumer Behavior; D003365:Costs and Cost Analysis; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D011787:Quality of Health Care; D011897:Random Allocation; D014861:Washington