Sofaer S, Hurwicz M L
Department of Health Care Sciences, George Washington University Medical Center, Washington, DC 20037.
Med Care. 1993 Sep;31(9):808-21. doi: 10.1097/00005650-199309000-00006.
Medicare beneficiaries who enroll in "risk contract" Health Maintenance Organizations (HMOs) are covered for services only if they are provided or approved by the HMO. Thus, their enrollment decisions involve selecting a health care delivery system and may be influenced by whether the HMO has contracts with particular providers. Disenrollment decisions, in turn, may be influenced by breaks in contracts between the HMO and its medical groups. This study examines decisions made by Medicare HMO enrollees when their HMO terminated its relationship with a major medical group; the group then signed a contract with a competing HMO. Beneficiaries were forced to choose between remaining with their HMO and switching to another provider, and switching to the competing HMO where they could keep their provider. Beneficiaries demonstrated considerable loyalty to their providers; nearly 60% switched to the competing HMO. Previous research on health care coverage decisions has been based on models which did not address consumers' knowledge, options, and information sources. In this decision context, we found that knowledge and information sources were the most important determinants of beneficiary decisions.
参加“风险合同”健康维护组织（HMO）的医疗保险受益人只有在HMO提供或批准服务时才能享受保险。因此，他们的参保决定涉及选择一个医疗服务提供系统，并且可能会受到HMO是否与特定医疗服务提供者签订合同的影响。反过来，退保决定可能会受到HMO与其医疗团队之间合同中断的影响。本研究考察了医疗保险HMO参保人在其HMO终止与一个主要医疗团队的关系时所做出的决定；该医疗团队随后与一家竞争的HMO签订了合同。受益人被迫在留在原HMO和更换到另一个医疗服务提供者之间做出选择，或者更换到能留住其医疗服务提供者的竞争HMO。受益人对其医疗服务提供者表现出了相当的忠诚度；近60%的人更换到了竞争的HMO。以往关于医疗保险覆盖范围决策的研究是基于一些未涉及消费者知识、选择和信息来源的模型。在这种决策背景下，我们发现知识和信息来源是受益人决策的最重要决定因素。
