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N Engl J Med. 2002 Apr 25;346(17):1288-93.

Assessments of medical care by enrollees in for-profit and nonprofit health maintenance organizations.

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Center for Studying Health System Change, Washington, DC 20024, USA.



It is uncertain how assessments of medical care differ between enrollees in for-profit and nonprofit health maintenance organizations (HMOs).


We analyzed the relation between the profit status of HMOs and enrollees' assessments of their care. We used data from two national surveys from the Community Tracking Study: the Household Survey, 1996-1997, and the 1997-1998 Insurance Followback Survey. The final sample included 13,271 persons under 65 years of age (10,654 adults and 2617 children) with employer-sponsored insurance who obtained health care through an HMO. A total of 12,445 enrollees who reported their health status as excellent, very good, or good were considered to be healthy; 826 with self-reported fair or poor health were considered to be sick.


In the sample as a whole, enrollees in nonprofit plans were more likely to be very satisfied with their overall care than enrollees in for-profit plans (adjusted means, 64.0 percent and 58.1 percent, respectively; P=0.01). Among enrollees in for-profit HMOs, sick enrollees were more likely than healthy enrollees to report unmet need or delayed care (17.4 percent vs. 13.1 percent, P=0.004) and organizational or administrative barriers to care (12.9 percent vs. 9.0 percent, P<0.001); they also reported higher out-of-pocket spending during the previous year ($731 vs. $480, P=0.002). For nonprofit HMOs, there was only one significant difference between the ratings of healthy and sick enrollees; sick enrollees expressed more trust in doctors to refer when needed.


Although there are few overall differences in assessments of medical care between enrollees in for-profit and nonprofit HMOs, for-profit HMOs are rated less favorably than nonprofit HMOs by patients who have self-reported fair or poor health.

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