Extending health maintenance organization insurance to the uninsured. A controlled measure of health care utilization.
OBJECTIVE
To investigate the utilization of health care services of previously uninsured low-income patients after becoming insured by a health maintenance organization (HMO).


METHODS
Retrospective study of utilization in a previously uninsured study group compared with an age- and sex-matched randomly selected control group of commercial HMO enrollees.


METHODS
Group model HMO.


METHODS
A study group of 346 previously uninsured low-income patients and 382 controls.


METHODS
utpatient visits for primary and specialty care, outpatient pharmacy, laboratory, and radiology use, and inpatient admissions and hospital days over a 2-year period. Self-reported health status measures were obtained to control for differences in health status.


RESULTS
There were no differences between the study and control groups in hospital admissions, hospital days, and measures of outpatient laboratory, pharmacy, and radiology use. The odds of having an outpatient visit per patient per month was 30% higher for the study group. Approximately half the increase in the odds ratio for outpatient visits was related to the worse self-perceived health status of the study group. While both groups utilized more services in the early phase of their enrollment, the intensity of this start-up effect was similar for both groups.


CONCLUSIONS
Compared with a commercial group of the same age and sex, the patterns of utilization were similar and the financial costs of care were only moderately more for a previously uninsured group provided with comprehensive HMO insurance. With the growth of managed care, these data should be beneficial in the development of health care programs for the growing number of uninsured Americans.
Bograd
H
H
Department of Pediatrics, Kaiser Permanente of Colorado, Denver 80205, USA.
Ritzwoller
D P
DP
Calonge
N
N
Shields
K
K
Hanrahan
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States; D014600:Utilization Review