Use of Preventive Care Services, Beneficiary Characteristics, and Medicare HMO Performance.

The superior performance of HMOs in providing preventive care--both in the population at-large (Miller and Luft, 1994), and within the elderly Medicare population (Ballard et al., 1997; Potosky et al., 1998; Retchin and Brown, 1990)--may be due to the favorable organizational, infrastructural, or cultural characteristics of managed care systems. For example, HMOs have historical roots in a health maintenance and wellness orientation (Lawrence, Mattingly, and Ludden, et al., 1997). HMOs also encourage patients to have a primary care provider, and they have been leaders in the use of technologies like computerized reminder systems, which are effective in promoting the regular use of preventive care services (Mandelson and Thompson, 1998). However, other factors may also contribute to HMO successes in the preventive care arena. Managed care enrollees typically face few financial barriers to care. To the extent that HMOs offer no-cost or low-cost preventive care services, and to the extent that cost is a barrier to receiving preventive care in the FFS sector, HMOs are likely to perform better. It is also possible that those who enroll in HMOs are attitudinally and behaviorally more receptive to preventive care. For example, some studies have found HMO enrollees to be better educated, healthier, and more optimistic about the benefits of preventive care than their FFS counterparts (Bernstein, Thompson, and Harlan, 1991; Porrell and Turner, 1990; Lichtenstein et al., 1992).