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: 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.
McKinlay JB, Marceau LD. Quality of Health Care and the HMO Marketplace. JAMA. 2000;283(5):602-605. doi:10.1001/jama.283.5.601