Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 1998 Aug;33(3 Pt 2):741–766.

HMO data systems in population studies of access to care.

R Fink 1
PMCID: PMC1975649  PMID: 9685114

Abstract

OBJECTIVES: A review of the current status of HMO data sets and their applicability to population studies of access to care. DATA SOURCES: Publications and reports based on research among different models of HMOs; reviews of HMO quality of care by national organizations; and HMO industry profiles. STUDY DESIGN: Design was a literature review of the content of HMO data sets: completeness of reporting, processing, and reporting. DATA COLLECTION: Publications and publicly available reports were reviewed. PRINCIPAL FINDINGS: Most HMOs are able to aggregate the number of services provided but demonstrate little ability to provide patient profiles. While their content is limited, HMO data sets are significant improvements over indemnity plan data, and where available, their accuracy in measuring health services utilization is superior to that of surveys. There are important differences among HMO delivery systems in their ability to provide useful data for population studies. CONCLUSIONS: A valuable resource, HMO data are limited by their content and the relative inaccessibility to IPAC-HMO information. This could be improved through new financial and technical support to HMOs interested in research.

Full text

PDF
741

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brand D. A., Quam L., Leatherman S. Medical practice profiling: concepts and caveats. Med Care Res Rev. 1995 Jun;52(2):223–251. doi: 10.1177/107755879505200204. [DOI] [PubMed] [Google Scholar]
  2. DENSEN P. M., BALAMUTH E., DEARDORFF N. R. Medical care plans as a source of morbidity data. The prevalence of illness and associated volume of service. Milbank Mem Fund Q. 1960 Jan;38:48–101. [PubMed] [Google Scholar]
  3. Dresser M. V., Feingold L., Rosenkranz S. L., Coltin K. L. Clinical quality measurement. Comparing chart review and automated methodologies. Med Care. 1997 Jun;35(6):539–552. doi: 10.1097/00005650-199706000-00001. [DOI] [PubMed] [Google Scholar]
  4. Epstein A. M., Begg C. B., McNeil B. J. The use of ambulatory testing in prepaid and fee-for-service group practices. Relation to perceived profitability. N Engl J Med. 1986 Apr 24;314(17):1089–1094. doi: 10.1056/NEJM198604243141706. [DOI] [PubMed] [Google Scholar]
  5. Garnick D. W., Luft H. S., Hunt S. S. Office visit patterns in physician group practices. GHAA J. 1986 Winter;7(2):13–21. [PubMed] [Google Scholar]
  6. Gold M., Tucker A., Palsbo S. The comparative database for managed care systems: an initiative to develop uniformity and consensus on data for a maturing industry in an uncertain environment. J Ambul Care Manage. 1989 Nov;12(4):38–47. doi: 10.1097/00004479-198911000-00008. [DOI] [PubMed] [Google Scholar]
  7. Greenfield S., Nelson E. C., Zubkoff M., Manning W., Rogers W., Kravitz R. L., Keller A., Tarlov A. R., Ware J. E., Jr Variations in resource utilization among medical specialties and systems of care. Results from the medical outcomes study. JAMA. 1992 Mar 25;267(12):1624–1630. [PubMed] [Google Scholar]
  8. Greenfield S., Rogers W., Mangotich M., Carney M. F., Tarlov A. R. Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes study. JAMA. 1995 Nov 8;274(18):1436–1444. [PubMed] [Google Scholar]
  9. Hornbrook M. C., Goodman M. J. Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment. Health Serv Res. 1996 Aug;31(3):283–307. [PMC free article] [PubMed] [Google Scholar]
  10. Howell E. M. Medicaid managed care encounter data: what, why, and where next? Health Care Financ Rev. 1996 Summer;17(4):87–95. [PMC free article] [PubMed] [Google Scholar]
  11. Jones K. R., Vischi T. R. Impact of alcohol, drug abuse and mental health treatment on medical care utilization. A review of the research literature. Med Care. 1979 Dec;17(12 Suppl 2):1–82. [PubMed] [Google Scholar]
  12. Luft H. S., Greenlick M. R. The contribution of group- and staff-model HMOs to American medicine. Milbank Q. 1996;74(4):445–467. [PubMed] [Google Scholar]
  13. Luft H. S. How do health-maintenance organizations achieve their "savings"? N Engl J Med. 1978 Jun 15;298(24):1336–1343. doi: 10.1056/NEJM197806152982404. [DOI] [PubMed] [Google Scholar]
  14. Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
  15. McFarland B. H., Freeborn D. K., Mullooly J. P., Pope C. R. Utilization patterns among long-term enrollees in a prepaid group practice health maintenance organization. Med Care. 1985 Nov;23(11):1221–1233. doi: 10.1097/00005650-198511000-00001. [DOI] [PubMed] [Google Scholar]
  16. Miller R. H., Luft H. S. Managed care plan performance since 1980. A literature analysis. JAMA. 1994 May 18;271(19):1512–1519. [PubMed] [Google Scholar]
  17. Quam L., Ellis L. B., Venus P., Clouse J., Taylor C. G., Leatherman S. Using claims data for epidemiologic research. The concordance of claims-based criteria with the medical record and patient survey for identifying a hypertensive population. Med Care. 1993 Jun;31(6):498–507. [PubMed] [Google Scholar]
  18. Quick J. D., Greenlick M. R., Roghmann K. J. Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. Am J Public Health. 1981 Apr;71(4):381–390. doi: 10.2105/ajph.71.4.381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Robinson J. C., Gardner L. B., Luft H. S. Health plan switching in anticipation of increased medical care utilization. Med Care. 1993 Jan;31(1):43–51. doi: 10.1097/00005650-199301000-00003. [DOI] [PubMed] [Google Scholar]
  20. SHAPIRO S., WEINER L., DENSEN P. M. Comparison of prematurity and perinatal mortality in a general population and in the population of a prepaid group practice, medical care plan. Am J Public Health Nations Health. 1958 Feb;48(2):170–187. doi: 10.2105/ajph.48.2.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Scitovsky A. A., Benham L., McCall N. Use of physician services under two prepaid plans. Med Care. 1979 May;17(5):441–460. doi: 10.1097/00005650-197905000-00001. [DOI] [PubMed] [Google Scholar]
  22. Shapiro S., Williams J. J., Yerby A. S., Densen P. M., Rosner H. Patterns of medical use by the indigent aged under two systems of medical care. Am J Public Health Nations Health. 1967 May;57(5):784–790. doi: 10.2105/ajph.57.5.784. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Simon G. E., VonKorff M., Durham M. L. Predictors of outpatient mental health utilization by primary care patients in a health maintenance organization. Am J Psychiatry. 1994 Jun;151(6):908–913. doi: 10.1176/ajp.151.6.908. [DOI] [PubMed] [Google Scholar]
  24. Sparer G., Anderson A. Utilization and cost experience of low-income families in four prepaid group-practice plans. N Engl J Med. 1973 Jul 12;289(2):67–72. doi: 10.1056/NEJM197307122890204. [DOI] [PubMed] [Google Scholar]
  25. Stearns S. C., Wolfe B. L., Kindig D. A. Physician responses to fee-for-service and capitation payment. Inquiry. 1992 Winter;29(4):416–425. [PubMed] [Google Scholar]
  26. Tarlov A. R., Ware J. E., Jr, Greenfield S., Nelson E. C., Perrin E., Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA. 1989 Aug 18;262(7):925–930. doi: 10.1001/jama.262.7.925. [DOI] [PubMed] [Google Scholar]
  27. Weiner J. P., Dobson A., Maxwell S. L., Coleman K., Starfield B., Anderson G. F. Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ Rev. 1996 Spring;17(3):77–99. [PMC free article] [PubMed] [Google Scholar]
  28. Wells K. B., Burnam M. A., Rogers W., Hays R., Camp P. The course of depression in adult outpatients. Results from the Medical Outcomes Study. Arch Gen Psychiatry. 1992 Oct;49(10):788–794. doi: 10.1001/archpsyc.1992.01820100032007. [DOI] [PubMed] [Google Scholar]
  29. Wells K. B., Hays R. D., Burnam M. A., Rogers W., Greenfield S., Ware J. E., Jr Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study. JAMA. 1989 Dec 15;262(23):3298–3302. [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES