There has been a great deal of interest in recent years in developing
measures of health care quality that can be used to characterize and study
the effects of health plans. However, because of the recent emergence of diverse
types of health care organizations, it is often difficult to know which parts
of a plan should be combined for analysis purposes. Also, simple taxonomies
of health maintenance organizations (eg, staff, independent practice associations,
group, and network) no longer adequately describe the diverse types of organizations
that have become common. In this article we describe these trends, explain
why older taxonomies of health care plans are not adequate, and present a
new framework for characterizing and studying the effects of diverse types
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