Opinions are deeply divided over whether rewarding physicians for lowering costs decreases trust in physicians or insurers. To explore the effects of disclosing physician payment methods in HMOs, members of two similar HMO plans were randomized to intervention and control groups, and the experimental arm was told how the HMO paid their primary care physician. Separate disclosures were developed...

BACKGROUND The "gatekeeping" model of access to specialty care has been an essential managed care tool, intended to control costs of care and promote coordination between generalists and specialists. OBJECTIVE To investigate the impact of removing gatekeeping on specialist utilization. METHODS A capitated multispecialty group discontinued a gatekeeping system on April 1, 1998. We assessed t...

Rapid medical care cost growth is one of the primary economic and fiscal challenges that policy makers wrestle with in the Unites States. Nationwide, medical expenses have grown at a rate approximately double the rate of inflation over the past two decades, in part due to price increases, in part due to quantity increases, and in part due to the introduction of new medical technologies. Medical...

OBJECTIVES To compare the effectiveness of 2 system-level multifaceted quality improvement approaches to enhancing the secondary prevention of domestic violence (DV) in health maintenance organization (HMO) primary care settings. STUDY DESIGN A "2 new interventions" pre/post design that compared a basic implementation strategy using current staff levels with an augmented basic strategy that a...

OBJECTIVE To describe the effects of a long-term intervention including 72% of Israeli diabetes patients, aimed at improving diabetes care in a primary care setting. DESIGN A retrospective periodic population-based cross-sectional study. SETTING Two health maintenance organizations (HMOs) in Israel-intervention and control. PARTICIPANTS All diagnosed diabetes patients enrolled in both HMO...

BACKGROUND Health care in the United States is in the midst of a near perfect storm: strong cost pressures, dramatic redesign efforts like patient-centered medical homes and accountable care organizations, and a broad series of payment and eligibility reforms. To date, alternative models of care intended to reduce costs and improve outcomes have shown mixed effects in the U.S., in part due to t...

BACKGROUND Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which mak...

As health care organizations create larger networks, better coordination of primary and specialty care is paramount. Attention has focused on strengthening primary care by creating patient-centered medical homes. The "medical neighborhood" provides a framework for structured, reciprocal relationships that integrate specialty care and extend the principles of the medical home to all practicing p...

OBJECTIVE To address training demands on future neurologists, the American Academy of Neurology (AAN) surveyed its US members as to their views about training the future neurology workforce. METHODS The survey was mailed to 575 US neurologists and 425 residents/fellows. Respondents (54%) were asked about their perceptions of current and future educational programs and settings needed to impro...