Out-of-plan use under two prepaid plans.
This analysis of out-of-plan use of physician and paramedical services under a Kaiser plan and under a prepaid option offered by a predominantly fee-for-service group practice (Clinic plan) deals primarily with services that members could have obtained from plan providers ("covered services"). The extent and pattern of out-of-plan use were found to be similar. While 16-20 per cent of plan members used some out-of-plan covered services and the mean number of such services was about one half visit per member per year, most out-of-plan user were occasional user, 10-12 per cent of user (or 2 per cent of plan members) accounting for 50 per cent of all out-of-plan covered services. The principal members characteristics associated with out-of-plan use were dissatisfaction, health status and having other insurance. The literature on out-of-plan use is also reviewed.
D000293:Adolescent; D000328:Adult; D002140:California; D002648:Child; D003258:Consumer Behavior; D005069:Evaluation Studies as Topic; D005260:Female; D005382:Financing, Personal; D006123:Group Practice / Q000706:statistics & numerical data*; D006125:Group Practice, Prepaid / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007357:Insurance, Physician Services / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors