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February 2, 2000

Quality of Health Care and the HMO Marketplace

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor


Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2000

JAMA. 2000;283(5):602-605. doi:10.1001/jama.283.5.601

To the Editor: In analyzing the association of for-profit status with HMO medical quality, Dr Himmelstein and colleagues1 avoid a logical conclusion in favor of a provocative one. Finding that not-for-profit HMOs outperformed investor-owned HMOs in each of 14 NCQA measures, they conclude that the profit motive causes reduced quality. Even if one accepts as plausible the idea that the participating physicians would independently limit immunizations and other care (none of the measured services require precertification), what is puzzling is the idea that HMOs could so successfully execute such a delicate objective. In an industry in which performance measures can yield a grab bag of results, inducing HMO physicians to perform well enough to secure accreditation, but poorly enough to save the profit margin, is quite a trick.

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