Scutchfield F D, de Moor C
West J Med. 1989 Feb;150(2):221-5.
To identify the self-reported differences in preventive practices, attitudes, and beliefs of physicians practicing in fee-for-service (FFS) and health maintenance organization (HMO) settings, we surveyed a 100% sample of primary care physicians practicing in a large, urban, closed-panel HMO and a random sample of physicians, in the same county, who were in an FFS practice. The FFS physicians were more likely to consider behavioral risk factors important than were HMO physicians, and they were more likely to ask their patients about behavioral risk factors. Fee-for-service physicians were more likely than HMO physicians to use continuing medical education courses to upgrade their skills in modifying behavioral risk factors. There was little difference in the self-reported proportion of patients with specific behavioral risks in the FFS and HMO practices. Also, both groups were comparable in their perception of their ability to do behavioral counseling and their perceived success in such counseling. We conclude that FFS physicians are more likely to have positive preventive beliefs, attitudes, and practices than are HMO physicians.
为了确定按服务收费（FFS）模式和健康维护组织（HMO）模式下执业医生在预防措施、态度和信念方面自我报告的差异，我们对一家大型城市封闭式医保机构中执业的所有基层医疗医生以及同一县内随机抽取的按服务收费模式执业医生进行了调查。与HMO医生相比，FFS医生更有可能认为行为危险因素很重要，也更有可能询问患者的行为危险因素。按服务收费模式的医生比HMO医生更有可能利用继续医学教育课程来提升其改变行为危险因素的技能。FFS模式和HMO模式下自我报告的具有特定行为风险的患者比例几乎没有差异。此外，两组在对自身进行行为咨询的能力感知以及在这种咨询中的感知成功率方面相当。我们得出结论，与HMO医生相比，FFS医生更有可能拥有积极的预防信念、态度和做法。
