March 2008
Background
While the enrollment of members in for-profit investor-owned health maintenance organizations (HMOs) was increasing, there was little known about the quality of care of these plans versus not-for-profit HMOs.
Objective
To compare quality-of-care measures in for-profit investor-owned and not-for-profit HMOs.
Design
Fourteen standardized quality-of-care indicators (derived from the Analysis of the Health Plan Employer Data and Information Set, HEDIS*) from over 329 HMO plans, representing 56% of total HMO enrollment in the US.
Results
Compared with not-for-profit HMOs, investor-ownedHMOs had lower rates for all 14 quality-of-care indicators.Among patients discharged from the hospital after myocardialinfarction, 59.2% of members in investor-owned HMOs vs 70.6%in not-for-profit plans received a BETA-blocker (P<.001); 35.1%of patients with diabetes mellitus in investor-owned plans vs47.9% in not-for-profit plans had annual eye examinations (P<.001).Investor-owned plans had lower rates than not-for-profit plansof immunization (63.9% vs 72.3%; P<.001), mammography (69.4%vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001)and psychiatric hospitalization (70.5% vs 77.1%; P<.001).In multivariate analyses, investor ownership was consistentlyassociated with lower quality after controlling for model type,geographic region, and the method each HMO used to collect data.
Limitations
The HEDIS quality indicators have shortcomings, such as not appraising the outcomes of care. Medicare HMOs may also encourage sick patients to disenroll and selectively recruit and enroll healthy individuals. Few HEDIS measurements address care for seriously ill or chronically ill patients who are financially unattractive to HMOs and who are, therefore, at risk for underservice. Sick patients could, therefore, be underrepresented in the data set, albeit the HEDIS data were the best available at the time of this study and remain useful.
Relevance
Investor-owned HMOs deliver lower quality of care than not-for-profit plans. Although total costs are similar in investor-owned and not-for-profit plans, the latter spend more on patient care. This paper suggests that market-driven, investor-owned medicine has serious shortcomings and that the then decade-old experiment with market medicine was a failure in part because the drive for profit appears to compromise quality of care.
Quality of Care in Investor-Owned vs Not-for-Profit HMOs. D. U. Himmelstein et al. JAMA, July 14, 1999. Vol 282; (2) 159-163.
Related Articles/Posts
- No. 02: A Systematic Review and Meta-Analysis of S...February 2008 Background The hypothesis that private for-profit health care results in increased efficiency and quality of care is examined. Objective To co...
- No. 29: Quality of Care in For-Profit and Not-For-...May 2010 Backgound Medicare’s commitment to nursing home care in Canada is ill-defined and variable, resulting in a patchwork of for-profit and not-for-profit...
- The Problem with Profit-Driven Health Care...What does the evidence say about private, for-profit health care? It’s not what you think. Having more private, for-profit clinics reduces access to care P...
- No. 01: A Systematic Review of Studies Comparing H...January 2008 Background Although Canada and the United States share many of the same standards for treatment, health outcomes in both countries vary. This dif...
- No. 17: Care Outcomes in Long-Term Care Facilities...May 2009 Background Publicly funded, long-term care in Canada is delivered through a widely variable mix of for-profit and not-for-profit facilities, with for...
- No. 04: Effect of the Ownership of Dialysis Facili...April 2008 Background At the time of this study, over 200,000 patients in the United States with end-stage renal disease were undergoing dialysis, mostly (2/3...
- Bottom 10: Practices to Avoid in Health Care Tran...As Canadian Doctors for Medicare illustrated in its Top 10, there are many ideas that have been shown to improve quality and efficiency while preserving or...
- State is stifling innovation at hospitals: health-...May 8, 2012 National Post Tom Blackwell The head of a controversial “executive” health clinic made a spirited call Tuesday for more entrepreneurship in Canad...
- The Chaoulli Decision...What is the “Chaoulli case”? Chaoulli v. Quebec (Attorney General) involved a patient who had to wait several months for hip replacement surgery. Together with...
- OP-ED: For-profit plasma clinics are risky busines...July 22, 2013 Healthy Debate Dr. Monika Dutt Last month, after the publication of an open letter by a large group of health professional organizations and he...
- Mobile medical screening clinic preying on seniors...April 25, 2013 CBC News Medical professionals are a raising concerns that a private mobile health clinic offering medical screening services around B.C. is pr...
- Paying for blood plasma raises new questions ...April 25, 2013 CBC News By: Kelly Crowe Health Canada says private clinics may pay donors for plasma, but critics wonder what is behind the push for a major...
- Should federal and provincial regulators allow pla...April 12, 2013 Toronto Star By: Isabel Teotonio The donation clinic sits empty. Reclining chairs await donors willing to roll up their sleeves for $20. State...
- Doctors want more answers about for-profit blood p...March 14, 2013 CTV News The federal government is considering approval for three new clinics in Ontario that would pay donors who give blood plasma. But a key...
- For-profit Health Care...
- Private clinics could save health system: OMA...October 2, 2011 The Ottawa Citizen Pauline Tam Specialized providers cost less, take stress off hospitals, medical association argues OTTAWA — While Dal...
- Stop for-profit blood clinics, doctors urge ...March 13, 2013 CBC News Introducing a paid-donor system for blood products could compromise Canada's blood supply and is not justified, a group of physicians ...
- Blood plasma clinics a sign of privatization in he...March 13, 2013 Toronto Star By: Theresa Boyle A group of doctors concerned about increasing privatization in Canada’s health-care system has added its voice ...
- Don't allow for-profit blood clinics, say doctors...March 12, 2013 TORONTO - A controversial and secretive new move by the federal government to approve for-profit blood plasma donation services that pays donors...
- Should we pay for blood? ...April 15, 2013 Maclean's By: Anne Kingston On March 11, federal Health Minister Leona Aglukkaq took to Twitter to issue her first public response to media re...