Difference in the use of preventive services between fee-for-service plans and HMOs: is more better?
OBJECTIVE
Based on the US Preventive Services Task Force recommendations, we studied how health insurance type, ie, fee-for-service (FFS) or health maintenance organization (HMO), affects the utilization of preventive services of differing effectiveness.


METHODS
Household survey data from the 1993 and 1994 National Health Interview Surveys.


METHODS
We compared the use of mammograms, Pap smears, blood pressure measurements, counseling about hormone replacement therapy (HRT), and general physical examinations in FFS plans and HMOs. We used the bivariate probit model to control for selection bias caused by the unobservable factors in the choice of health insurance type.


RESULTS
Enrollees in HMOs obtained more Pap smears, blood pressure measurements, mammograms (women 40 to 49 years old), and general physical examinations than enrollees in FFS plans. No significant difference was found between FFS plans and HMOs for the use of mammograms (women aged 30 to 39 years and 50 to 64 years) or HRT counseling. The correlation ratios from bivariate probit estimations indicated no selection bias favoring HMOs; for some preventive services, selection bias favored FFS plans.


CONCLUSIONS
Compared with enrollees in FFS plans, persons in HMOs used more preventive services, including less effective ones. Not controlling for selection bias underestimated the HMO effect.
Wang
Y Richard
YR
Public Policy Department, AstraZeneca Pharmaceuticals, Wilmington, Del 19850-5437, USA. y.richard.wang@astrazeneca.com
Pauly
Mark V
MV
D000328:Adult; D000368:Aged; D005191:Family Characteristics; D018588:Fee-for-Service Plans / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States