National Study of the Impact of Health Maintenance Organizations on Health Care use by Patients with Rheumatoid Arthritis

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National Study of the Impact of Health Maintenance Organizations on Health

Care use by Patients with Rheumatoid Arthritis

Category:  30 Health services research

Yelin1, Trupin1, Katz1, Deborah Lubeck1, Lee Wanke2,

Buatti3

1University of California, San Francisco, San Francisco, CA;2Immunex

Corporation, Seattle, WA;3Wyeth-Ayerst, St. 's, PA

Presentation Number: 151

Poster Board Number: 151

Keywords: managed care, utilization, rheumatoid arthritis

BACKGROUND: Prior studies of the impact of health maintenance organizations

(HMOs) on health care use among persons with rheumatoid arthritis (RA) were

limited to local areas or predate the recent growth in managed care.

OBJECTIVE: The present study is designed to provide a contemporary

assessment of the impact of HMOs on health care for persons with RA in the

nation as a whole.

METHODS: The source of the data is RAPOLO, a longitudinal, observational

study of persons with RA who had previously participated in etanercept

clinical trials. The data are acquired through structured telephone

interviews conducted quarterly over a year based on standardized batteries

of questions about RA status, overall health status, demographics, health

care use, and HMO status. We compare health care use over a year among

persons with RA in HMOs to that of persons in all other types of plans

(non-HMO). Ordinary least squares regression is used to assess the impact of

HMO versus non-HMO status on MD visits for RA and non-RA and allied health

visits for RA. Adjustments are made for age, gender, race/ethnicity, marital

status, education, overall health status, comorbidity, duration of RA,

number of painful and number of swollen joints, global rating of RA status

and pain, and HAQ. Logistic regression is used to assess impact of HMO

versus non-HMO status on hospital admissions and outpatient surgeries for RA

and non-RA reasons, adjusted for duration of RA and HAQ.

RESULTS: Subjects are 489 persons with RA from the practices of 59

rheumatologists across the country. 189 (30.3%) were treated in HMOs and 434

(69.7%) were treated in non-HMOs. Health care utilization in each group is

presented in the table.

  HMO Non-HMO Difference (95% CI)

MD Visits for RA (#) 7.8 7.4 0.4 (-0.7, 1.7)

MD Visits for Non-RA Reasons (#) 6.4 5.8 0.6 (-0.5, 1.7)

Allied Health Visits for RA (#) 2.7 3.9 -1.2 (-3.1, 0.5)

% with RA Hospital Admissions 8.3% 6.2% 2.1% (-3.2%, 7.3%)

% with Non-RA Hospital Admissions 13.7% 19.1% -5.4% (-12.4%,

1.6%)

% with RA Outpatient Surgeries 5.3% 7.8% -2.5% (-7.2%, 2.2%)

% with Non-RA Outpatient Surgeries 18.8% 21.7% -2.9% (-10.7%,

4.8%)

CONCLUSION: The results suggest that persons with RA who are treated in HMOs

do not use less ambulatory care or have fewer hospital admissions for RA

than those not in HMOs. However, the results are less definitive with

respect to outpatient surgery and non-RA admissions.