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October 19, 1984

Use of HMOs

Author Affiliations

University of Rochester School of Medicine and Dentistry Rochester. NY

JAMA. 1984;252(15):2006-2007. doi:10.1001/jama.1984.03350150012007

To the Editor.—  Drs Jackson-Beeck and Kleinman present evidence of favorable self-selection among HMO enrollees in the Minneapolis area. Their findings, which have been supported in local studies,1,2 will undoubtedly generate discussion between HMO advocates and opponents. But policymakers concerned with medical care cost containment must consider more than an enrollee's prior experience. The effectiveness of the HMO in controlling utilization immediately after the enrollee joins is a critical factor in judging the success of the HMO concept.Several important points should be clarified regarding the study by Roghmann et al1 cited by Jackson-Beeck and Kleinman. This study involved persons who joined each of three prepaid plans introduced in Rochester, NY, in 1973. The inpatient hospital utilization experience was analyzed for calendar year 1972 (one year prior to joining) and calendar years 1974 and 1975 (the two years after enrollment). The object of this study was to control