Health outcomes for a chronic disease in prepaid group practice and fee for service settings. The case of rheumatoid arthritis.
The authors compare health care use and outcomes of a panel of persons with rheumatoid arthritis receiving health care in prepaid group practice and fee-for-service settings. In 1982, they randomly sampled one half of all 114 board-certified or eligible rheumatologists in Northern California. Those who participated provided the names of all patients with rheumatoid arthritis presenting during a 1-month period; 812 of these patients (97% of those listed) were interviewed. In 1984, 745 of them (92% of the baseline cohort) were interviewed; 569 receive care in fee-for-service settings and 176 in prepaid group practice. As in the baseline survey year, the prepaid patients received similar amounts and kinds of health care as their fee-for-service counterparts. The prepaid and fee-for-service patients achieved similar outcomes, as measured by symptoms of illness, functional status, and work disability. The fee-for-service patients reported poorer overall health status. The authors conclude, after 2 years of follow-up study, that patients in prepaid group practice receive similar medical care inputs and achieve outcomes at least as good as those in fee-for-service.
D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000191:economics*; D002140:California; D002908:Chronic Disease; D005251:Fees, Medical; D005260:Female; D006123:Group Practice / Q000592:standards*; D006125:Group Practice, Prepaid / Q000592:standards*; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011331:Private Practice / Q000592:standards*; D012219:Rheumatology