Impact of HMO ownership on management processes and utilization outcomes.
OBJECTIVE
To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization.


METHODS
We used 1995 HMO data from the American Association of Health Plans.


METHODS
Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix.


RESULTS
HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management.


CONCLUSIONS
HMO ownership type affects utilization outcomes and management strategies.
Ahern
M
M
Health Policy and Administration Program, Washington State University at Spokane, Spokane, WA, USA. ahemm@wsu.edu
Molinari
C
C
D019090:Case Management; D017047:Cost Sharing; D003430:Cross-Sectional Studies; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008330:Management Audit; D010043:Outcome and Process Assessment, Health Care; D010067:Ownership; D012044:Regression Analysis; D014481:United States; D014600:Utilization Review