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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

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

To the Editor: Leaving aside the admitted "serious shortcomings" of the HEDIS quality indicators used in the study by Dr Himmelstein and colleagues,1 some of the reported differences between investor-owned and so-called not-for-profit HMOs appear modest—while statistically significant these differences may not be meaningful or useful for setting policy. The author's example of mammography rates to buttress their argument is particularly unfortunate: the clinical usefulness of mammography has been widely questioned.1 Similar doubts have also been long expressed concerning Pap tests. We question the estimate of lives likely to be saved given the known unreliability of these tests and controversy concerning their predictive value.

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