Mode of payment and identification with a regular doctor. A prospective look at reported use of services.

Despite the apparent success of health maintenance organizations (HMOs) in lowering the costs of health care, they have been criticized for other reasons, including the lack of doctor-patient continuity in the patient's having a regular doctor. Consistent with previous research, HMO members sampled from Los Angeles County (N = 190) were less likely to identify with a regular doctor than comparable fee-for-service (FFS) subscribers (N = 653) (P less than 0.001). When differences in this variable were not controlled statistically, HMO members reported higher rates of physician visits, but only for acute respiratory problems (P less than 0.05). It was not until differences in having a regular doctor were taken into account that HMO members were found to report higher rates of use for all symptoms (P less than 0.05) as well as for digestive problems (P less than 0.10). These findings suggest the importance of taking physician-patient continuity into account when comparing utilization rates across health plans. Additionally, few differences were found in reports of morbidity, although HMO members were less likely to report cold symptoms during this 1-year survey than comparable FFS subscribers (P less than 0.05).