Physicians Who Are Experts On Managed Care Avoid Enrolling In HMOs When Selecting A Personal Health Insurance Plan

For Immediate Release: Monday April 29, 2002

Boston, MA — In the first study to examine the personal health insurance choices made by scholars who study managed care, researchers from the Harvard School of Public Health and RAND found that physician experts shy away from health maintenance organizations (HMOs) when choosing a health plan for themselves and their families.  The study findings appear in the April 29 issue of the journal Medical Care.

The researchers surveyed 279 professors at 17 universities across the country who were prominent experts in managed care.  They also surveyed “controls,” consisting of other professors at the same institutions who did not study health care but had the same health plan choices available to them.  Comparisons of these two groups showed that the experts who were physicians were almost half as likely to choose an HMO plan.  Instead, the physician experts were attracted to fee-for-service and point-of-service options—the kinds of plans that have fewer restrictions on access to services and choice of physician.

In addition, physician experts, regardless of income level and non-physician experts with income above $150,000 were less likely than their matched counterpart to choose an HMO plan. The likelihood of choosing an HMO among the non-experts changed dramatically between those with moderate income levels (39.1 percent enrolled in HMOs) and those with high income levels (14 percent enrolled in HMOs).

“It is not clear why physician experts tend to steer away from HMOs,” said David Studdert, lead author of the study, and assistant professor of health policy and law in the Department of Health Policy and Management at the Harvard School of Public Health.  “These doctors may have stronger distaste for the constraints that HMOs impose.  Through their work, they may have preferences for specific providers and facilities that are not part of the HMO network on offer.  However, one cannot rule out the possibility that the experts’ choices stem from special insights into managed care that non-experts don’t have.”

The study also found that experts who were not physicians made similar choices to non-experts overall.  But when participants with high income were excluded from the comparison the experts were again less likely to choose HMO coverage. 

Studdert said, “What is clear from our results is that it’s the physicians, the people who are closest to the bedside and who almost certainly have the most direct experience with managed care, who were the least likely to choose HMOs.”

For further information, please contact:

Kevin Myron
Office of Communications
Harvard School of Public Health
677 Huntington Avenue
Boston, MA 02115
Phone: 617-432-4388

Studdert DM, Bhattacharya J, Schoenbaum M, Warren B, Escarce JJ.
Personal Choices Of Health Plans By Managed Care Experts,
Medical Care, Vol. 40, No. 5, May 2002, pp. 375-386.

Expert opinion has not been used as a basis for comparing different forms of health insurance, in part because this perspective may not be appropriately sensitive to aspects of care that consumers value.

Using a case-control design, managed care experts were surveyed at 17 academic institutions in the United States to determine the type of health plan they chose (fee-for-service, HMO, POS, PPO, or catastrophic). Controls consisted of academicians from other disciplines at these institutions who ostensibly faced the same insurance options. We then compared the choices of physician experts, nonphysician experts and controls using a multinomial logit model that was sensitive to the choice set available at each institution. We also examined the choice behavior of respondents within moderate (<$150,000) and high (>/=$150,000) income levels.

Four hundred thirty-seven experts and 465 controls were surveyed and responses were received from 73.7% and 52.7%, respectively. Physician experts were approximately half as likely (14.9%) as controls (26.6%) or nonphysician experts (27.6%) to enroll in HMO plans. In moderate-income households, both physicians (Relative Risk [RR] = 0.42; P <0.01) and nonphysician experts (RR = 0.71; P <0.1) were less likely than controls to opt for an HMO. Experts' propensity to choose HMO coverage varied little with income, whereas controls' propensity changed dramatically between moderate (39.1% in HMOs) and high (14.0% in HMOs) income categories.

The aversion of physician experts, and nonphysician experts with moderate income, to HMO plans may be caused by their stronger distaste for the constraints on choice and access that typically accompany HMO coverage. Alternatively, it may be explained by their superior ability to absorb, understand, and use information about available insurance options. Insights into quality in managed care may also play a role.