Enrollment factors and preexisting medical conditions in a prepaid capitated plan. A comparison of university and nonuniversity clinic enrollees.

Traditional wisdom suggests that academic medical centers attract sicker patients than nonacademic facilities, thereby incurring greater risk when caring for patients enrolled in prepaid health care plans. This study examines the affiliation of an academic medical center with a prepaid capitation-based medical plan in western Washington state and focuses on demographic characteristics, prior existing medical conditions, recent utilization, and factors affecting enrollee choice of health care plan, clinic, and physician. It was hypothesized that university clinic enrollees would differ from nonuniversity clinic enrollees with regard to many of these factors. A questionnaire was sent to a random sample of 400 university clinic enrollees and 759 enrollees in nonuniversity, private practice settings. The response rate was 56.1%. Results showed that, when compared with nonuniversity clinic enrollees in the same plan, university clinic enrollees were significantly younger and had more formal education. University clinic enrollees reported less health care utilization and expressed fewer strong preferences than nonuniversity clinic enrollees in choosing a health care plan, clinic, and physician. Based on this survey, there was no evidence that the academic medical center attracted sicker HMO enrollees than did nonuniversity clinics.