Ernest W. Saward

Comparing the Use of Medical Care Services by a Medically Indigent and a General Membership Population in a Comprehensive Prepaid Group Practice Program

The utilization of medical-care services by the general membership of a prepaid group practice program is compared with that of the participants of an OEO Comprehensive Neighborhood Health Center Program. This OEO program provides medical care for 1,500 urban indigent families by integrating them on a prepaid capitated basis into the Kaiser Foundation Health Plan in Portland, Oregon. Generally, the findings indicate that the rate and patterns of utilization between the two populations are essentially similar. The only major differences are: 1. that the adult males of the poverty population use a significantly higher rate of services with a high emotional component, and 2. that the poverty population fails to keep scheduled appointments at a significantly higher rate than the health plan members. The data indicate that much of the reported differences in medical care utilization between poverty groups and other sections of the general population seem to disappear when financial and other barriers are removed. Many of the reported differences in the behavior of poverty populations appear to relate to differential access to care.

Documentation of Twenty Years of Operation and Growth of a Prepaid Group Practice Plan

THE SEEDS of the Kaiser Foundation Medical Care Plan were sown in the California desert and at the Coulee Dam site before World War II. The fundamentals of this medical care organization and the story of its growth into a system which now provides comprehensive health services for more than 1.7 million people has been documented.2,3 However, this story can well be supplemented by examination of the development of the program in Oregon, as a case study in the birth and growth of a community-based medical care program. Two separate but similar Permanente Foundations were inaugurated in 1942, one in the Oakland, California area and one in the Portland, Oregon area. It was not until 1960 that they were legally joined, although they were founded on the same principles. The geographical separation and legal autonomy allows study of the Oregon region independent of the larger structure. This region is one of the pioneer prepaid group practice plans. It has grown and prospered and now serves

The Utilization and Cost of Home Care and Extended Care Facility Services in a Comprehensive, Prepaid Group Practice Program

We report here a project designed to provide the home care and extended care facility services presently available under Medicare to a population of more than 100,000 people under 65 years of age in a comprehensive, prepaid group practice program. Data are presented on the impact of these services on the use of hospital care by the population. Costs and utilization data are presented, and the total cost of home care, extended care facility, and hospital service is compared to the previous cost of acute hospital alone. The project demonstrated that these services can be readily integrated into a prepaid group practice program. The demonstration successfully implemented the much discussed concept of progressive patient care.

The effect on future physician requirements of an HMO policy after national health insurance.

The questions examined in this paper are: What effect will the Health Maintenance Organization (HMO) have on future physician manpower? What is the likelihood of there being a substantial movement of medical practice to the HMO form? Answers indicate that national health insurance will produce a more regulated and constrained resource allocated to health services and, hence, the demonstrated efficiencies of the HMO form will have strong appeal. The reduced physician manpower use of this type of organization is described. The result of these interactions will probably be a substantial reduction in the ratio of physicians needed 20 years from now.