Abstract
A sample of 1,042 adults was drawn from an employed population who were given the option of enrollment in any of three prepaid, HMO-type organizations, one of which was an open-panel foundation, or continued subscription in a conventional Blue Cross/Blue Shield plan. The subjects in the sample were interviewed to examine three hypothesized relationships: (1) Enrollees in any HMO will exhibit higher levels of health concern than members of other health plans. (2) Users of preventive services will exhibit a higher level of health concern than nonusers. (3) Expressed health concern is a predictor of the rate of preventive use. Data were analyzed by bivariate and multivariate techniques. Support was found for each hypothesis. We found that, although the level of perceived health status did not vary across enrollees in the various plans, those who chose a closed-panel plan reported the highest level of health concern. Health concern was positively related to the use of preventive services, and the mean number of visits as well as the percentage of individuals who use them were the largest for the members of the closed-panel plans. We also found that health concern was a predictor of preventive use. Regression analysis was used to explore various relationships between health status, health concern, plan membership, and the use of preventive services. The hypothesis of adverse self-selection is questioned. The generalizability of the findings is limited to employed, essentially middle-income groups.
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Additional information
The authors are, respectively, Professor, Research Associate, Professor, and Research Associate in the Department of Medical Care Organization, School of Public Health, The University of Michigan, Ann Arbor, Michigan 48109. This paper was presented in part at the 104th Annual Meeting of the American Public Health Association, October 17–21, 1976. The work herein reported was supported by grant OEO 51517, Evaluation of the Community Health Networks, now administered by the National Center for Health Services Research. The opinions expressed are those of the authors and should not be construed as representing the opinions of any agency of the United States Government.
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Berki, S.E., Ashcraft, M., Penchansky, R. et al. Health concern, HMO enrollment, and preventive care use. J Community Health 3, 3–31 (1977). https://doi.org/10.1007/BF01319140
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DOI: https://doi.org/10.1007/BF01319140