| Sumario: | Part of a special section on health-care service delivery in an evolving managed care environment. A study was conducted to compare the health status of health maintenance organization (HMO) enrollees with that of non-HMO enrollees. Data were drawn from 863 HMO enrollees with standard risk contracts and from 4,576 respondents in fee-for-service residing in counties with at least one HMO respondent. Results revealed that, after controlling for demographics and area of residence, HMO respondents were less likely to report fair or poor health, functional impairment, or heart disease. In addition, average predicted costs, based on various health-status measures, were substantially lower for HMO respondents than for the comparison group. It is concluded that the Medicare payment formula for HMOs does not adequately adjust for the better health and consequent lower expected costs of HMO enrollees and that the addition of health-status measures would improve payment accuracy and significantly reduce average HMO payments.
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