Garfinkel S A, Schlenger W E, McLeroy K R, Bryan F A, York B J, Dunteman G H, Friedlob A S
Med Care. 1986 Jul;24(7):628-40. doi: 10.1097/00005650-198607000-00006.
This article identifies factors that influence the choice between joining an HMO and remaining with the traditional fee-for-service system among aged Medicare beneficiaries in three communities. Sources of marketing information were found to be strongly and positively related to the decision to join the HMO. Among beneficiaries who had to switch providers to join, persons who had a prior usual source of care and those who were satisfied with the amount of paperwork required to use that source of care were less likely to enroll in the HMO. Persons who did not have to switch providers to join the HMO were more likely to enroll in the prepaid program if they were satisfied with the amount of paperwork involved in using the HMO prior to the demonstration. Differences among the three communities suggest that the barrier to HMO enrollment presented by having a prior source of care who is not affiliated with the HMO may attenuate as the number of competing HMOs in the community increases, making the medical care environment more competitive. In the community with the most HMOs, persons who already had supplemental insurance were less likely to enroll than those who did not. None of the six HMOs studied experienced adverse selection, based on pre-enrollment health status.
本文确定了在三个社区中影响老年医疗保险受益人在加入健康维护组织（HMO）和留在传统按服务收费体系之间做出选择的因素。研究发现，营销信息来源与加入HMO的决定呈强烈正相关。在那些必须更换医疗服务提供者才能加入HMO的受益人中，有先前常规医疗服务来源的人以及对使用该医疗服务来源所需的文书工作量感到满意的人，加入HMO的可能性较小。对于那些无需更换医疗服务提供者就能加入HMO的人，如果他们在示范之前对使用HMO所涉及的文书工作量感到满意，那么他们更有可能加入预付计划。三个社区之间的差异表明，随着社区中相互竞争的HMO数量增加，即医疗保健环境更具竞争性，由拥有与HMO无关的先前医疗服务来源所带来的加入HMO的障碍可能会减弱。在HMO最多的社区中，已经拥有补充保险的人比没有补充保险的人加入的可能性更小。基于参保前的健康状况，所研究的六个HMO均未出现逆向选择。
