Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care

UMMS Affiliation

Department of Quantitative Health Sciences

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Adolescent; Adult; Cholesterol; Cost-Benefit Analysis; *Fees, Medical; *Health; *Health Maintenance Organizations; *Health Status; Humans; Income; Insurance, Health; Length of Stay; Middle Aged; Mortality; *Outcome and Process Assessment (Health Care); Patient Admission; Quality of Health Care; Regression Analysis; Risk; Washington


Biostatistics | Epidemiology | Health Services Research


To determine whether health outcomes in a health maintenance organisation (HMO) differed from those in the fee-for-service (FFS) system, 1673 individuals ages 14 to 61 were randomly assigned to one HMO or to an FFS insurance plan in Seattle, Washington for 3 or 5 years. For non-poor individuals assigned to the HMO who were initially in good health there were no adverse effects. Health outcomes in the two systems of care differed for high and low income individuals who began the experiment with health problems. For the high income initially sick group, the HMO produced significant improvements in cholesterol levels and in general health ratings by comparison with free FFS care. The low income initially sick group assigned to the HMO reported significantly more bed-days per year due to poor health and more serious symptoms than those assigned free FFS care, and a greater risk of dying by comparison with pay FFS plans.

DOI of Published Version



Lancet. 1986 May 3;1(8488):1017-22. Link to article on publisher's site

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Link to Article in PubMed