Scheckler W E, Schulz R
J Fam Pract. 1987 Apr;24(4):417-24.
Dane County (Madison), Wisconsin, has experienced a dramatic transformation of its health services into competing closed-panel health maintenance organizations (HMOs). The change occurred literally overnight after the state, as the dominant employer, implemented price competition. In 1983, 22 percent of the 24,000 state employees in Dane County were enrolled in closed-panel HMOs; in 1984 about 85 percent enrolled in one of seven major competing physician HMO plans. In 1985 state employees basically stayed with the HMO they had chosen in 1984, and the only major shift was continued movement away from the standard fee-for-service plan. The Dane County HMO plans were less costly than fee-for-service plans to the state and to the state employee. Fee-for-service state enrollees self-reported greater use of inpatient hospital services and self-reported poorer health than employees selecting HMOs when controlling for age between the two groups. This article describes these changes, why they occurred, and the initial impact on employees as an example relevant to HMO development that may occur elsewhere.
威斯康星州戴恩县（麦迪逊市）的医疗服务经历了戏剧性的转变，变成了相互竞争的封闭式医疗维护组织（HMO）。在该州作为主要雇主实施价格竞争后，这种变化几乎在一夜之间就发生了。1983年，戴恩县24000名州雇员中有22%加入了封闭式HMO；1984年，约85%的雇员加入了七个主要的相互竞争的医生主导型HMO计划之一。1985年，州雇员基本上继续留在他们1984年选择的HMO，唯一的主要变化是继续远离标准的按服务收费计划。对该州和州雇员来说，戴恩县的HMO计划比按服务收费计划成本更低。在控制两组年龄差异后，按服务收费的州参保人自我报告称，他们比选择HMO的雇员更多地使用住院医院服务，且自我报告的健康状况更差。本文描述了这些变化、变化发生的原因以及对雇员的初步影响，作为一个可能在其他地方发生的与HMO发展相关的例子。
