HMO Preventive Care Better

HMO's have been in the news in recent years being lambasted for poor quality care, lack of choice and for denial of needed medical care. Especially under fire has been the payment model for physicians known as capitation . But a study from Wake Forest University may help change the notion that managed care is all bad.

Capitation is a model of payment for physicians whereby the HMO pays the doctor a fixed amount for each covered life they have in their practice. The physician's income is based on the difference in amount between what is spent per patient and what is paid. Services such as specialist referrals additional office visits and expensive lab and radiology tests add up to additional costs for the primary care provider. The fear was that physicians would provide as little care as possible and increase the number of patients in their practice in order to maximize profits. According to a Wake Forest University School of Medicine study published in the April 2002 issue of The American Journal of Managed Care, 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. The researchers from Wake Forest compared physicians in a capitated payment system to physicians who are compensated in different manners. They also studied the variations in the amount of time spent with patients among doctors receiving different type of payments under managed care.

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.

The researchers found that "physicians responded ethically to capitation incentives by treating patients consistently, despite varying methods of payment." They also felt that should dispel some of the fears associated with capitation payment, which rewards doctors for holding costs down.

According to Rajesh Balkrishnan, Ph.D., assistant professor of public health sciences and lead author on the study "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."

Researchers also found that 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.

Updated 04/25/06
Sources: American Journal of Managed CareApril 2002