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This study examines the economic consequences of non-financial measures of performance in contracts between health maintenance organizations (HMOs) and primary care physicians (PCPs). HMOs have expanded contractual arrangements to give physicians not only financial incentives to control costs, but also to make the physicians accountable for the quality of patient care. Specifically, we examine how quality provisions in HMO–PCP contracts affect utilization (patient length of stay in the hospital), patient satisfaction, and HMO costs. Our results show that quality clauses are associated with a statistically significant increase in utilization (29 more hospital days annually per 1,000 HMO enrollees). Further, inclusion of quality clauses in PCP contracts also led to a significant increase in patient satisfaction, but no associated increase in HMO costs. Overall, these results suggest that quality clauses in PCP contracts can increase value by increasing customer satisfaction without significantly increasing cost.

This paper examines the health care experiences of older adults over a five-year period, including continuity in care, changes in health insurance coverage, and satisfaction with care.

Face-to-face interviews were conducted annually with 415 older adults (mean age = 84, range = 72–105), 100 of whom were originally health maintenance organization (HMO) subscribers and 315 of whom were receiving fee-for-service care. Several predictors of health care experiences were examined, including personal characteristics, health status and health care variables. Coverage type (HMO or fee-for-service) was the most consistent predictor. HMO subscribers were more likely than fee-for-service recipients to experience changes in insurance (both negative and positive changes) and discontinuity in physician care, although satisfaction with care did not vary among HMO and non-HMO members. Two-thirds of HMO subscribers and nearly one-third of fee-for-service recipients reported changes in insurance coverage over the five-year study period. In terms of perspectives on HMO care, the most frequently mentioned advantage of HMO care among those in HMOs was diminished costs, while fee-for-service subscribers did not believe there were any advantages to being in an HMO. Those not in HMOs viewed loss of physician choice and poor quality care as major disadvantages of HMOs. Results of this study demonstrate that older adults commonly experience changes in their health care coverage and physician care. They adapt to these changes through positive appraisals of the type of case they receive.

The purpose of this paper is to estimate whether health maintenance organizations (HMO) physicians are more price sensitive than non‐HMO physicians in their prescribing behavior of brand‐name substitutes.

The study uses physician level data and a set of 13 drugs for the years 1997‐2000 to estimate the price sensitivity of HMO and non‐HMO physicians. A two‐part model is used to measure the price elasticity of brand‐name prescribing for HMO physicians. The first part uses a logit model to examine the physician's choice to prescribe the same drug to all patients with the same medical condition, or whether physicians alternate prescriptions among brand‐name substitutes. The second part employs OLS to estimate the influence of managed care, i.e. HMOs, on physician price sensitivity.

The results suggest that HMO physicians are less likely than non‐HMO physicians to prescribe a common drug to all patients with a specific medical condition, but rather HMO physicians exhibit more diversified prescribing behavior. Correspondingly, HMO physicians are more price sensitive in prescribing brand‐name substitutes, than non‐HMO physicians, exhibiting price elasticities of prescribing ranging from −1.707 to −1.823. The analysis suggests that HMOs have a modest influence on encouraging physicians to be more price sensitive in their prescribing of brand‐name substitutes. HMO physicians are more price sensitive in their prescribing behavior than non‐HMO physicians.

This paper provides insight into the effectiveness of HMOs in altering physician prescribing behavior and price sensitivity of pharmaceutical prices. The results provide suggestions on how HMOs can improve the cost‐effectiveness of physician prescribing behavior.

We determined access and satisfaction of 2,598 recipients of Virginia’s Medicaid program, comparing its health maintenance organizations (HMOs) to its primary care case management (PCCM) program. Positive responses were summed as sub‐domains either of access, satisfaction, or of utilization, and adjusted odds ratios were calculated for HMO (vs. PCCM) sub‐domain scores. The response rate was 47 per cent. We found few significant differences in perceived access, satisfaction, and utilization. Both HMO adults and children more often perceived good geographic access (adults, OR, [CI] = 1.50, [1.04‐2.16]; children, OR, [CI] = 1.773 [1.158, 2.716]). But HMO patients less often reported good after‐hours access (adults, OR, [CI] = 0.527 [0.335, 0.830]; children, OR, [CI] = 0.583 [0.380, 0.894]). Among all patients reporting poorer function, HMO patients more often reported good general and preventive care (OR, [CI] = 2.735 [1.138, 6.575]). We found some differences between Medicaid HMO versus PCCM recipients’ reported access, satisfaction, and utilization, but were unable to validate concerns about access and quality under more restrictive forms of Medicaid managed care.

In the USA, health maintenance organizations (HMOs) have pledged to control health care costs. Many patients have complained about the quality of care under the HMO regime and limits imposed on them, particularly access to care. Has quality of care been degraded under the HMO regime, resulting in an impact on patient satisfaction? There have been many studies that have compared the satisfaction of HMO patients with that of patients in the traditional fee‐for‐service payment system. The aim of this paper is to review HMO patient satisfaction.

A review of patient satisfaction under managed care arrangements with a focus on HMOs. The article describes the US history of managed care and its effect on the satisfaction of several patient categories including the general population, vulnerable patients and the elderly.

There is much information available on patient satisfaction with their insurers and most surveys indicate the lack of choice of a provider – a major source of discontent. Therefore, patient protection laws are necessary to avoid abuse.

Patients have little ability or are not willing to rely on the information available when selecting a provider. The paper discusses patient awareness regarding satisfaction surveys and how the latter can be used when patients are seeking care.

How do organizations act as entrepreneurs and what are the outcomes of their innovations? This paper intersects two broad areas of organizational research: the sociology of entrepreneurship and the study of organizational forms. A case study of Kaiser Permanente's role as an institutional entrepreneur in the creation of the health maintenance organization form illuminates the benefits and pitfalls of institutional entrepreneurship – in this case, the act of turning identity into form. Examining organizations as institutional entrepreneurs also raises questions and challenges for future research about both entrepreneurs and models of organizing.

This paper examines how medical practice, like all other productive activities, has been subject to the transformative elements of the forces and the relations of production involving class struggle and intra-class conflict. It will explore changes in the relations of production of medical practice which have been catalyzed by powerful productive forces. The current period of medical production involves the transformation of simple commodity production into a transitional stage of capitalist production with the seemingly unbounded growth of the medical productive forces. This development was precipitated by the intervention of capital as a whole, to restrict the drain on their variable capital through the placement of units of financial capital into the management of medical production, using the leverage of access to patients. In response, physicians have consolidated and centralized their practices to create enterprises with market power to limit the extraction of surplus by financial capital, and by their own employment of productive labor to extract surplus from hired physician labor and other clinical workers. Rationalization of the production of medical service commodities, and the sharing of surplus generated from exploitation of an expanded labor force by managed care financial capital and their capitalist partners owning medical enterprises, constitutes the contemporary relations of production. The contradictions of this mode of medical production and the potential for its reproduction will be analyzed.

The purpose of this research is to examine the potential contribution of private branding to the service sector, and to integrate private branding into the SERVQUAL model.

A total of 300 customers of a health maintenance organization (HMO) were asked about the five dimensions of the service‐quality model and about several aspects of their HMO's private brand.

The study finds that satisfaction with service quality among subjects who were aware of the HMO's private brand was higher than that of unaware subjects when asked directly. In addition, a positive relationship was found between the perceptions of service quality in the HMO and the evaluation of a private brand in the HMO those customers who were aware of the private brand. The data analysis suggests that private branding constitutes an additional (sixth) dimension in the SERVQUAL model.

This research was conducted during the initial stages of the market penetration of the HMO's private brand.

HMOs, and other service providers, should consider private branding as a pivotal strategy in reinforcing service quality.

This research is of importance for service providers because it identifies private branding strategy as having significant marketing potential for improving service quality.

Previous research has established that there is a relationship between housing and mental health, however, understanding about how and why housing affects mental health is still limited. The purpose of this paper is to address this deficit by focusing on the experiences of residents of houses in multiple occupation (HMOs).

Semi-structured interviews were carried out with 20 HMO residents who were asked about their housing career and experience of living in a HMO. Participants were recruited with assistance from community organisations and landlords.

The physical properties and social environment of the property, as well as personal circumstances experienced prior to the move into the property, all influenced how mental health was affected. The authors identify and discuss in detail three key meditating factors: safety, control and identity which may affect how living in the property impacts the mental health of tenants.

Good property management can lessen the potential harmful effects of living in a HMO. However, poorly run properties which house numerous vulnerable people may increase the risk of poor mental health due to attendant high levels of stress and possible risk of abuse.

Based on the reports of HMO residents, the authors outline the key mediating processes through which living in HMOs may affect mental wellbeing, as well as illuminating the potential risks and benefits of HMOs, an overlooked tenure in housing research.

Perhaps the most remarkable event in the US medical market in the last ten years has been the astonishing growth of the new kinds of health‐care delivery systems that are collectively known as health maintenance organisations (HMOs). Indeed, they are now posing a serious threat to the conventional insurance sector which has traditionally covered most Americans. According to data collected by the US Department of Health and Human Services and the Minnesota research foundation, InterStudy, some 18.9 million people were enrolled in an HMO in June 1985, so that the 400 HMOs then in existence accounted for roughly nine per cent of the health‐care market. Today's figures are undoubtedly higher, and one New York investment company expects that ‘by 1990, 75 million people, or 30 per cent of the population, will be members of HMOs’, with the organisations achieving ‘membership expansion and revenue growth of 30–40 per cent a year’