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
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.
Maniccia M. Quality of Health Care and the HMO Marketplace. JAMA. 2000;283(5):602-605. doi:10.1001/jama.283.5.601