| Sumario: | Part of a special section on delivery and financing issues in access to health care services in rural areas of the U.S. A study was conducted to determine the extent to which health maintenance organizations (HMOs) provide services to Medicare beneficiaries in rural areas. The findings revealed that only 17 of the 38 HMOs that have Medicare risk contracts and provide coverage to commercial clients in rural counties include the rural counties in their Medicare plan service areas. The rural counties in which HMOs offer Medicare coverage have higher adjusted average per capita costs (AAPCCs), bigger populations, and a greater number of physicians per capita than do those rural counties that are excluded from the Medicare risk plans. Interviews with HMOs revealed that low and erratic AAPCCs, scarcity of potential enrollees, lack of negotiating power with physicians, and adverse selection were the main disadvantages to initiating the Medicare plan in rural areas.
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