Not-for-Profit HMO Members More Likely to Be Satisfied with Care Than Those in For-Profit HMOs, Study Finds

Enrollees in not-for-profit HMOs are more likely to be "very satisfied" with their care than those in for-profit HMOs, according to a study published in today's New England Journal of Medicine. Using information from the 1996-97 Community Tracking Study and the 1997-98 Insurance Followback Survey, researchers from the Center for Studying Health System Change analyzed the responses of 13,271 people under the age of 65, including 2,617 children (Tu/Reschovsky, NEJM, 4/25). Sixty-four percent of people in not-for-profit plans said they were very satisfied with their overall care, compared to 58.1% of members of for-profit plans. Not-for-profit members also reported paying lower annual out-of-pocket costs than for-profit members -- $440 v. $498. In addition, among the 826 respondents in fair or poor health -- classified as "sick" by the study -- members in not-for-profit HMOs reported spending an average of $507 annually in out-of-pocket costs, compared to $731 for members of for-profit plans. Sick enrollees in for-profit HMOs were also more likely to report being unsatisfied with their interaction with their physicians and less satisfied with their care overall.

Examining differences between sick and healthy members within the two types of HMOs, the study found that sick members of for-profit HMOs were less likely than healthy enrollees in for-profit plans to believe their physicians would put their medical needs before costs -- 58.7% to 64.2%. Conversely, 67.7% of sick enrollees in not-for-profit HMOs said they thought their doctor put their medical needs first, compared to 60.7% of healthy members of not-for-profit plans. "That sick people in [not-for-profit] plans have greater trust in their physicians than healthy people is striking and suggests that the plan's profit status has some bearing on the patient-physician relationship," Ha Tu, a health researcher at HSC and the study's co-author said. In addition, the study found that sick members in for-profit HMOs were more likely to report "unmet needs or delayed care" and that they faced "organizational or administrative barriers to care." Sick enrollees in for-profit HMOs also faced much higher annual out-of-pocket costs than healthy members of for-profit plans -- $731 v. $480. In contrast, sick and healthy members of not-for-profit HMOs reported "no such differences." Tu cautioned that the study did not indicate whether actual quality of care differed for members of for-profit and not-for-profit HMOs, adding that clinical measures were needed to answer that question (HSC release, 4/24).