Assessments of Medical Care by Enrollees in For-Profit and Nonprofit Health Maintenance Organizations

BACKGROUND: It is uncertain how assessments of medical care differ between enrollees in for-profit and nonprofit health maintenance organizations (HMOs). METHODS: We analyzed the relation between the profit status of HMOs and enrollees' assessments of their care. We used data from two national surveys from the Community Tracking Study: the Household Survey, 1996-1997, and the 1997-1998 Insurance Followback Survey. The final sample included 13, 271 persons under 65 years of age (10, 654 adults and 2617 children) with employer-sponsored insurance who obtained health care through an HMO. A total of 12, 445 enrollees who reported their health status as excellent, very good, or good were considered to be healthy; 826 with self-reported fair or poor health were considered to be sick. RESULTS: In the sample as a whole, enrollees in nonprofit plans were more likely to be very satisfied with their overall care than enrollees in for-profit plans (adjusted means, 64. 0 percent and 58. 1 percent, respectively; P=0. 01). Among enrollees in for-profit HMOs, sick enrollees were more likely than healthy enrollees to report unmet need or delayed care (17. 4 percent vs. 13. 1 percent, P=0. 004) and organizational or administrative barriers to care (12. 9 percent vs. 9. 0 percent, P<0. 001) ; they also reported higher out-of-pocket spending during the previous year (731 vs. 480, P=0. 002). For nonprofit HMOs, there was only one significant difference between the ratings of healthy and sick enrollees; sick enrollees expressed more trust in doctors to refer when needed. CONCLUSIONS: Although there are few overall differences in assessments of medical care between enrollees in for-profit and nonprofit HMOs, for-profit HMOs are rated less favorably than nonprofit HMOs by patients who have self-reported fair or poor health.