HMO Patients More Likely To Get Health Counseling, Preventive Services
WINSTON-SALEM, N.C. – Patients of health maintenance organizations that pay their doctors a fixed amount for each "covered life" are more likely to get health counseling and preventive services, according to a Wake Forest University School of Medicine study published in the April issue of The American Journal of Managed Care. The Wake Forest researchers also found that these patients spend a few minutes less time actually seeing their doctors.
"The results of this study have national policy implications for the practice of medicine and payment to physicians under managed care," said Rajesh Balkrishnan, Ph.D., assistant professor of public health sciences and lead author on the study.
Balkrishnan and his colleagues focused on doctors who primarily were paid on a "capitation" basis -- the same amount for each enrolled patient each year, regardless of the number of doctor visits or additional costs associated with specialist and hospital referrals, and laboratory tests ordered. These doctors were compared with those paid in other ways.
"Capitation payment to doctors has often been feared to decrease quality of medical care, as there could be an economic incentive to provide as little care as possible per patient, and to maximize the number of patients under the doctor''s care," Balkrishnan explained.
Using the National Ambulatory Medical Care Survey for 1997 and 1998, the researchers found that patients in capitated plans "were 17 percent more likely to receive health counseling services" than patients in other health care systems.
And they found that these patients also were more likely to get preventive services, such as blood pressure and cholesterol checks, mammograms, PAP smears, and PSA tests. But their doctors spent an average of two minutes less time with them. Until this study, the investigators said, "relatively little evidence was available about the actual impact of different methods of physician payment on physician behavior and quality of care."
The team, which included faculty in public health sciences and dermatology, studied the variations in the amount of time spent with patients among doctors receiving different type of payments under managed care.
Balkrishnan said the researchers found that "physicians responded ethically to capitation incentives by treating patients consistently, despite varying methods of payment." He said that finding that dispels some of the fears associated with capitation payment, which rewards doctors for holding costs down.
"The cost-containment aspects of managed care have been heavily emphasized. However this study shows that payment incentives under managed care are also prompting physicians to encourage more preventive health behaviors that could potentially avoid serious medical events in many patients," Balkrishnan said.
“Physicians spent significantly more time with new patients, older patients, patients with multiple diagnoses, and patients taking multiple medications, irrespective of the way they were paid,” they said.
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