To the Editor.—
The special importance of the analysis by F. T. Nobrega et al in a recent issue of The Journal (1982;247:806) is to show that the health maintenance organization (HMO) approach is not indispensable to lower hospital usage—the principal cost-control mechanism. It may serve to clear the air in the factional dispute between the pro-HMO and anti-HMO adherents. (The title, however, is somewhat misleading since it seems to imply that the fee-for-service charge to patients is foreign to the HMO concept, despite the experience of those HMO models, the individual practice associations, that have a similar fee arrangement.)The question, however, arises: How is the lower hospitalization usage obtained in both settings? There are organizational clues in the wellresearched American Medical Association study on HMOs,1 and the report of Nobrega et al emphasizes such structural framework. Whatever the reasons, medical judgment with a rather wide latitude of
Palmer E. Hospital Utilization. JAMA. 1982;248(13):1577. doi:10.1001/jama.1982.03330130025008
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