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A Comparison of the Treatment of Rheumatoid Arthritis in Health Maintenance Organizations and Fee-for-Service Practices

List of authors.
  • Edward H. Yelin, Ph.D.,
  • Curtis J. Henke, Ph.D.,
  • Jane S. Kramer, M.SC.,
  • Michael C. Nevitt, Ph.D.,
  • Martin Shearn, M.D.,
  • and Wallace V. Epstein, M.D.

Abstract

This study compares the use of health care services (hospital and ambulatory) by patients with rheumatoid arthritis who were under the care of rheumatologists in prepaid and fee-for-service arrangements. Participating physicians from a random sample of half the rheumatologists in northern California maintained a log of all their patients with well-established diagnoses of rheumatoid arthritis. We interviewed 822 of their patients, using a structured, validated phone survey to obtain information about health care use. Patients in prepaid plans had about the same number and type of hospitalizations and the same rate of surgery as those receiving fee-for-service care. However, fee-for-service patients made more ambulatory visits.

We conclude that the use of expensive services (hospital admissions and surgery) for the care of patients with rheumatoid arthritis is not different in fee-for-service and prepaid settings. (N Engl J Med 1985; 312:962–7.)

Funding and Disclosures

Supported by a grant (AM-20684) from the National Institute of Arthritis, Diabetes, and Digestive and Kidney Diseases, and grants from the Robert Wood Johnson Foundation and the Research Committee, School of Medicine, University of California, San Francisco. The views expressed herein are not necessarily those of the funding agencies.

We are indebted to the 40 rheumatologists in northern California who gave their time freely so that this project could be completed, as well as to the 822 patients with rheumatoid arthritis who consented to be interviewed for this survey; to John Spencer, who performed the interviews; Roy Kriedeman, who coordinated all the many resources necessary to complete this research; and Dodie Collier, who helped to validate the survey results; and to Deborah Lubeck, Harold Luft, and Jonathan Showstack for providing substantive and methodologic suggestions to us at various points.

Author Affiliations

From the Multipurpose Arthritis Center, Robert Wood Johnson Clinical Scholars Program, and Institute for Health Policy Studies, University of California, San Francisco; and the Department of Medicine, Kaiser–Permanente Medical Center, Oakland, Calif.

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