Study Finds Doctors Likely to Shun HMOs

Researchers at the Harvard School of Public Health have found that the experts who know health maintenance organizations (HMOs) best avoid them the most when picking a plan for themselves and their families.

Their findings, released Monday in the journal Medical Care, surveyed 279 leading health care professors at 17 American universities. Compared to a control group of professors who do not study health care, the experts were nearly half as likely to choose an HMO plan for themselves.

“What is clear from our results is that it’s the physicians, the people who are closest to the bedside and who almost certainly have the most direct experience with managed care, who were the least likely to choose HMOs,” said David Studdert, the study’s lead author and assistant professor of health policy and management.

Instead of HMOs, the experts surveyed predominantly chose fee-for-service and point-of-service health care options.

But the doctors’ choices don’t necessarily indicate that HMO patient care is inferior, Studdert said.

“These doctors may have stronger distaste for the constraints that HMOs impose,” he said. “Through their work, they may have preferences for specific providers and facilities that are not part of the HMO network on offer.”

However, it is also possible that the doctors’ choices indicate flaws in the HMO system.

“One cannot rule out the possibily that the experts’ choices stem from special insights into managed care that non-experts don’t have,” he said.

The study, which Studdert has guided since 1999, also revealed that physicians in general, and non-physicians with yearly incomes above $150,000, were less likely to choose HMO care than non-physicians with lower incomes.

Thirty-nine percent of those with moderate-income levels chose HMOs, while only 14 percent of those with high-income levels opted for managed care.

It is unlikely that any changes in the health care system will be immediately forthcoming.

“I don’t think that there is any clear policy direction from these results,” Studdert said.

Instead, the data produced will serve as a springboard for further research. “What we will be able to do with these results is design more focused studies to discover what physicians were averse to,” Studdert said.