HMO HOSPITAL QUALITY: Varies by Region, Study Says
A new study of hospitals used by privately insured HMO patients for heart bypass surgery suggests that plan members in some regions of the country have access to better quality hospitals than do members in other regions. The study, conducted by researchers at RAND with a grant from the Agency for Health Care Policy and Research (AHCPR), compared expected-to-actual death rate ratios for heart bypass surgery, using Florida and California as two competing HMO markets. The study found that patients in Florida were "no less likely to use hospitals with average and high heart bypass surgery rates" than non-HMO patients. In California, however, a more mature managed care market, patients were "more likely to be directed to hospitals with lower than expected death rates." Lead RAND researcher Dr. Jose Escarce, said, "Whether HMO patients in states other than California and Florida use higher- or lower-quality hospitals for heart bypass surgery is likely to depend on whether their plans use objective data to measure health care quality when selecting facilities, and on the degree to which plans trade off higher quality for lower price." Escarce observed that HMO behavior appears to be influenced by the structure and maturity of managed care markets and the degree to which patients select HMOs based on quality.
Word to the Wise?
AHCPR's Dr. John Eisenberg said, "The nation's employers have the power to boost health care quality by selecting health plans that pay attention to information about quality. To exercise that power, they first need to act on what they already know -- that price should not be the only bottom line." Eisenberg said he hopes the study will add to the understanding that quality can be measured and that purchasers should make decisions based on quality. He said, "There are many managed care plans that deliver on their promise of quality. But the issue is not just managed care or not. The issue is high-quality care or not." The study may be found in the September issue of Medical Care Research and Review. (ACHPR release, 9/1).