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October 2, 1996, Vol 276, No. 13 >
ARTICLE | October 2, 1996

Health Care Utilization and Outcomes Among Persons With Rheumatoid Arthritis in Fee-for-Service and Prepaid Group Practice Settings FREE

Edward H. Yelin, PhD; Lindsey A. Criswell, MD, MPH; Paul G. Feigenbaum, MD
[+] Author Affiliations

Reprints: Edward H. Yelin, PhD, Arthritis Research Group, 1388 Sutter St, Suite 700, San Francisco, CA 94143-0920 (e-mail: yelin2@itsa.ucsf.edu).


JAMA. 1996;276(13):1048-1053. doi:10.1001/jama.1996.03540130046028
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References

Objective.  —To compare health care utilization and outcomes over an 11-year period among persons with rheumatoid arthritis (RA) in fee-for-service and prepaid group practice settings.

Design.  —Cohort of persons with RA followed up for as long as 11 years. The principal measures were obtained from an annual structured telephone interview conducted by a trained survey worker.

Setting.  —Persons with RA presenting to a random sample of community rheumatologists in northern California.

Patients.  —Patients were enrolled in 2 cycles: in 1982 and 1983 and in 1989. Study rheumatologists listed all persons meeting criteria for RA presenting to their offices over a 1-month period. Of the 1062 so listed, we enrolled 1025, or 96.5%. Of the 1025 persons with RA, 227 (22.2%) reported receiving care in prepaid group practice settings.

Main Outcome Measures.  —As of the end of 1994, 5295 person-years of observation were available for the analysis of the annual level of the utilization and outcome measures; 341 persons had been followed up for all 11 years of the study. The main utilization outcomes measured included office visits, outpatient surgeries, hospital admissions, and painful joints.

Results.  —The persons with RA in fee-for-service and prepaid group practice settings did not differ in the quantity of health care used in any 1 year for either RA or non-RA reasons. Among those followed up for all 11 years, the persons in feefor-service and prepaid group practice settings did not differ in the cumulative quantity of health care used over the entire period of study. The 2 groups did not differ on any outcome measure on either an annual or long-term basis. The results of mortality analyses were inconsistent: using Kaplan-Meier estimates, the persons with RA in prepaid group practice settings survived significantly longer (P<.05 by log-rank test); using Cox proportional hazards methods, the proportion dying each year did not differ significantly.

Conclusions.  —We could find no evidence that persons with RA in fee-forservice and prepaid group practice settings received different quantities of health care or experienced different outcomes on either an annual or long-term basis.

REFERENCES

1 +
Luft HS. Health Maintenance Organizations: Dimensions of Performance . New York, NY: John Wiley & Sons Inc; 1981;.
2 +
Luft HS.  How do health-maintenance organizations achieve their 'savings'? N Engl J Med . 1978;;298:1336-1343.
3 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med . 1984;;310:1505-1510.
4 +
Miller RH, Luft HS.  Managed care plan performance since 1980: a literature analysis . JAMA . 1994;;271:1512-1519.
5 +
Udvarhelyi S, Jennison K, Phillips RS, et al.  Comparison of the quality of ambulatory care for fee-for-service and prepaid patients . Ann Intern Med . 1991;;115:394-400.
6 +
Carey T, Weis K, Homer C.  Prepaid versus traditional Medicaid plans: effect on preventive health care . J Clin Epidemiol . 1990;;43:1213-1220.
7 +
Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE Jr.  Patients' ratings of outpatient visits in different practice settings: results from the Medical Outcomes Study . JAMA . 1993;;270:835-840.
8 +
Ware JE, Brook RH, Rogers WH, et al.  Comparison of health outcomes at a health maintenance organization with those of fee-for-service care . Lancet . 1986;;1:1017-1022.
9 +
Sloss EM, Keeler EB, Brook RH, et al.  Effect of a health maintenance organization on physiologic health: results from a randomized trial . Ann Intern Med . 1987;;106:130-138.
10 +
LoGerfo JP, Effird RA, Diehr PK, et al.  Rates of surgical care in prepaid group practices and the independent setting: what are the reasons for the difference . Med Care . 1979;;17:1-10.
11 +
Hlatky MA, Lee KL, Botvinick EH, Brundage BH.  Diagnostic test use in different practice settings: a controlled comparison . Arch Intern Med . 1983;;143:1886-1889.
12 +
Diehr PK, Williams SJ, Martin DP, et al.  Ambulatory mental health services utilization in three provider plans . Med Care . 1984;;22:1-13.
13 +
Wilner S, Schoenbaum SC, Monson RR, Winickoff RN.  A comparison of the quality of maternity care between a health-maintenance organization and fee-for-service practices . N Engl J Med . 1981;;304:784-787.
14 +
Lubeck DP, Brown BW, Holman HR.  Chronic disease and health system performance: care of osteoarthritis across three health services . Med Care . 1985;;23:266-277.
15 +
Francis AM, Polissar L, Lorenz AB.  Care of patients with colorectal cancer: a comparison of a health maintenance organization and fee-for-service practices . Med Care . 1984;;22:418-429.
16 +
Norquist GS, Wells KB.  How do HMOs reduce outpatient mental health care costs? Am J Psychiatry . 1991;;148:96-101.
17 +
Retchin SM, Brown B.  Management of colorectal cancer in Medicare health maintenance organizations . J Gen Intern Med . 1990;;5:110-114.
18 +
Rogers WH, Wells KB, Meredith LS, Sturm R, Burnam MA.  Outcomes for adult outpatients with depression under prepaid or fee-for-service financing . Arch Gen Psychiatry . 1993;;50:517-525.
19 +
Vernon SW, Hughes JI, Heckel VM, et al.  Quality of care for colorectal cancer in a fee-for-service and health maintenance organization practice . Cancer . 1992;;69:2418-2424.
20 +
Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr.  Detection of depressive disorder for patients receiving prepaid or fee-forservice care: results from the Medical Outcomes Study . JAMA . 1989;;262:3298-3302.
21 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study . JAMA . 1992;;267:1624-1630.
22 +
Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR.  Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus treated by different systems and specialties: results from the Medical Outcomes Study . JAMA . 1995;;274:1436-1444.
23 +
Yelin EH, Henke CJ, Kramer JS, Nevitt MC, Shearn M, Epstein WV.  A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices . N Engl J Med . 1985;;312:962-967.
24 +
Yelin EH, Shearn MA, Epstein WV.  Health outcomes for a chronic disease in prepaid group practice and fee-for-service settings . Med Care . 1986;;24:236-247.
25 +
Nevitt MC, Yelin EH, Henke CJ, et al.  Risk factors for hospitalization and surgery in patients with rheumatoid arthritis: implications for capitated medical payment . Ann Intern Med . 1986;;105:421-428.
26 +
Criswell LA, Redfern WJ.  Variation among rheumatologists in the use of prednisone and secondline agents for the treatment of rheumatoid arthritis . Arthritis Rheum . 1994;;37:476-480.
27 +
Kovar M, Poe G.  The National Health Interview Survey Design 1973-1984 and procedures 1975-1983 . Vital Health Stat 1 . 1985;;No. (18) .
28 +
Bye B, Schechter E. 1978 Survey of Disability and Work: Technical Introduction . Washington, DC: Social Security Administration; 1982;.
29 +
Mason JH, Anderson JJ, Meenan RF, et al.  The Rapid Assessment of Disease Activity in Rheumatology (RADAR) questionnaire: validity and sensitivity to change of a patient self-report measure of joint count and clinical status . Arthritis Rheum . 1992;;35:156-162.
30 +
Fries JF, Spitz P, Kraines RG, et al.  Measurement of patient outcome in arthritis . Arthritis Rheum . 1980;;23:137-145.
31 +
Felson DT, Anderson JJ, Boers M, et al.  The American College of Rheumatology preliminary set of disease activity measures for rheumatoid arthritis clinical trials . Arthritis Rheum . 1993;;36:729-740.
32 +
The SAS Institute Inc.  The mixed procedure . In: SAS Technical Report P-229 . Cary, NC: SAS Institute; 1992;.
33 +
Karim MR, Zeger SL. GEE: A SAS Macro for Longitudinal Data Analysis . Baltimore, Md: Dept of Biostatistics, Johns Hopkins University; 1988;. Technical Report No. 674.
34 +
Kaplan E, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
35 +
Cox D.  Regression models and life tables . J R Stat Soc . 1972;;34:187-220.
36 +
Trupin L, Rice DP, Max W. Medical Expenditures for People With Disabilities in the United States, 1987 . San Francisco: Disability Statistics Research and Training Program, University of California, San Francisco; 1995;.
37 +
Sullivan CB, Miller M, Feldman R, et al.  Employer-sponsored health insurance in 1991 . Health Aff (Millwood) . 1992;;11:172-185.
38 +
Weiner JP, deLissovoy G.  Razing a tower of babel: a taxonomy for managed care and health insurance plans . J Health Polit Policy Law . 1993;;18:75-103.
39 +
Gold MR, Hurley R, Lake T, et al.  A national survey of the arrangements managed-care plans make with physicians . N Engl J Med . 1995;;333:1678-1683.
40 +
Manheim LM.  Managed care and arthritis care: patients and providers under the new medical care organizations . Arthritis Care Res . 1995;;8:298-303.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Luft HS. Health Maintenance Organizations: Dimensions of Performance . New York, NY: John Wiley & Sons Inc; 1981;.
2 +
Luft HS.  How do health-maintenance organizations achieve their 'savings'? N Engl J Med . 1978;;298:1336-1343.
3 +
Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP.  A controlled trial of the effect of a prepaid group practice on use of services . N Engl J Med . 1984;;310:1505-1510.
4 +
Miller RH, Luft HS.  Managed care plan performance since 1980: a literature analysis . JAMA . 1994;;271:1512-1519.
5 +
Udvarhelyi S, Jennison K, Phillips RS, et al.  Comparison of the quality of ambulatory care for fee-for-service and prepaid patients . Ann Intern Med . 1991;;115:394-400.
6 +
Carey T, Weis K, Homer C.  Prepaid versus traditional Medicaid plans: effect on preventive health care . J Clin Epidemiol . 1990;;43:1213-1220.
7 +
Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE Jr.  Patients' ratings of outpatient visits in different practice settings: results from the Medical Outcomes Study . JAMA . 1993;;270:835-840.
8 +
Ware JE, Brook RH, Rogers WH, et al.  Comparison of health outcomes at a health maintenance organization with those of fee-for-service care . Lancet . 1986;;1:1017-1022.
9 +
Sloss EM, Keeler EB, Brook RH, et al.  Effect of a health maintenance organization on physiologic health: results from a randomized trial . Ann Intern Med . 1987;;106:130-138.
10 +
LoGerfo JP, Effird RA, Diehr PK, et al.  Rates of surgical care in prepaid group practices and the independent setting: what are the reasons for the difference . Med Care . 1979;;17:1-10.
11 +
Hlatky MA, Lee KL, Botvinick EH, Brundage BH.  Diagnostic test use in different practice settings: a controlled comparison . Arch Intern Med . 1983;;143:1886-1889.
12 +
Diehr PK, Williams SJ, Martin DP, et al.  Ambulatory mental health services utilization in three provider plans . Med Care . 1984;;22:1-13.
13 +
Wilner S, Schoenbaum SC, Monson RR, Winickoff RN.  A comparison of the quality of maternity care between a health-maintenance organization and fee-for-service practices . N Engl J Med . 1981;;304:784-787.
14 +
Lubeck DP, Brown BW, Holman HR.  Chronic disease and health system performance: care of osteoarthritis across three health services . Med Care . 1985;;23:266-277.
15 +
Francis AM, Polissar L, Lorenz AB.  Care of patients with colorectal cancer: a comparison of a health maintenance organization and fee-for-service practices . Med Care . 1984;;22:418-429.
16 +
Norquist GS, Wells KB.  How do HMOs reduce outpatient mental health care costs? Am J Psychiatry . 1991;;148:96-101.
17 +
Retchin SM, Brown B.  Management of colorectal cancer in Medicare health maintenance organizations . J Gen Intern Med . 1990;;5:110-114.
18 +
Rogers WH, Wells KB, Meredith LS, Sturm R, Burnam MA.  Outcomes for adult outpatients with depression under prepaid or fee-for-service financing . Arch Gen Psychiatry . 1993;;50:517-525.
19 +
Vernon SW, Hughes JI, Heckel VM, et al.  Quality of care for colorectal cancer in a fee-for-service and health maintenance organization practice . Cancer . 1992;;69:2418-2424.
20 +
Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr.  Detection of depressive disorder for patients receiving prepaid or fee-forservice care: results from the Medical Outcomes Study . JAMA . 1989;;262:3298-3302.
21 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study . JAMA . 1992;;267:1624-1630.
22 +
Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR.  Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus treated by different systems and specialties: results from the Medical Outcomes Study . JAMA . 1995;;274:1436-1444.
23 +
Yelin EH, Henke CJ, Kramer JS, Nevitt MC, Shearn M, Epstein WV.  A comparison of the treatment of rheumatoid arthritis in health maintenance organizations and fee-for-service practices . N Engl J Med . 1985;;312:962-967.
24 +
Yelin EH, Shearn MA, Epstein WV.  Health outcomes for a chronic disease in prepaid group practice and fee-for-service settings . Med Care . 1986;;24:236-247.
25 +
Nevitt MC, Yelin EH, Henke CJ, et al.  Risk factors for hospitalization and surgery in patients with rheumatoid arthritis: implications for capitated medical payment . Ann Intern Med . 1986;;105:421-428.
26 +
Criswell LA, Redfern WJ.  Variation among rheumatologists in the use of prednisone and secondline agents for the treatment of rheumatoid arthritis . Arthritis Rheum . 1994;;37:476-480.
27 +
Kovar M, Poe G.  The National Health Interview Survey Design 1973-1984 and procedures 1975-1983 . Vital Health Stat 1 . 1985;;No. (18) .
28 +
Bye B, Schechter E. 1978 Survey of Disability and Work: Technical Introduction . Washington, DC: Social Security Administration; 1982;.
29 +
Mason JH, Anderson JJ, Meenan RF, et al.  The Rapid Assessment of Disease Activity in Rheumatology (RADAR) questionnaire: validity and sensitivity to change of a patient self-report measure of joint count and clinical status . Arthritis Rheum . 1992;;35:156-162.
30 +
Fries JF, Spitz P, Kraines RG, et al.  Measurement of patient outcome in arthritis . Arthritis Rheum . 1980;;23:137-145.
31 +
Felson DT, Anderson JJ, Boers M, et al.  The American College of Rheumatology preliminary set of disease activity measures for rheumatoid arthritis clinical trials . Arthritis Rheum . 1993;;36:729-740.
32 +
The SAS Institute Inc.  The mixed procedure . In: SAS Technical Report P-229 . Cary, NC: SAS Institute; 1992;.
33 +
Karim MR, Zeger SL. GEE: A SAS Macro for Longitudinal Data Analysis . Baltimore, Md: Dept of Biostatistics, Johns Hopkins University; 1988;. Technical Report No. 674.
34 +
Kaplan E, Meier P.  Nonparametric estimation from incomplete observations . J Am Stat Assoc . 1958;;53:457-481.
35 +
Cox D.  Regression models and life tables . J R Stat Soc . 1972;;34:187-220.
36 +
Trupin L, Rice DP, Max W. Medical Expenditures for People With Disabilities in the United States, 1987 . San Francisco: Disability Statistics Research and Training Program, University of California, San Francisco; 1995;.
37 +
Sullivan CB, Miller M, Feldman R, et al.  Employer-sponsored health insurance in 1991 . Health Aff (Millwood) . 1992;;11:172-185.
38 +
Weiner JP, deLissovoy G.  Razing a tower of babel: a taxonomy for managed care and health insurance plans . J Health Polit Policy Law . 1993;;18:75-103.
39 +
Gold MR, Hurley R, Lake T, et al.  A national survey of the arrangements managed-care plans make with physicians . N Engl J Med . 1995;;333:1678-1683.
40 +
Manheim LM.  Managed care and arthritis care: patients and providers under the new medical care organizations . Arthritis Care Res . 1995;;8:298-303.

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