Because Drs. Yelin and Katz are Editors of Arthritis Care & Research, review of this article was handled by the Editor of Arthritis & Rheumatism.
Impact of health maintenance organizations and fee-for-service on health care utilization among people with systemic lupus erythematosus
Article first published online: 29 MAR 2007
Copyright © 2007 by the American College of Rheumatology
Arthritis Care & Research
Volume 57, Issue 3, pages 508–515, 15 April 2007
How to Cite
Yelin, E., Trupin, L., Katz, P., Criswell, L. A., Yazdany, J., Gillis, J. and Panopalis, P. (2007), Impact of health maintenance organizations and fee-for-service on health care utilization among people with systemic lupus erythematosus. Arthritis & Rheumatism, 57: 508–515. doi: 10.1002/art.22625
- Issue published online: 29 MAR 2007
- Article first published online: 29 MAR 2007
- Manuscript Accepted: 19 JUL 2007
- Manuscript Received: 11 MAY 2007
- Agency for Healthcare Research and Quality/National Institute of Arthritis and Musculoskeletal and Skin Diseases. Grant Number: 1-R01-HS013893
- State of California Lupus Fund
- Arthritis Foundation
- American College of Rheumatology Research and Education Foundation Physician Scientist Development award
- NIH. Grant Numbers: K24-AR02175, R01-AR44804
- Health care utilization;
- health maintenance organizations;
- Systemic lupus erythematosus
To compare health care utilization in people with systemic lupus erythematosus (SLE) in health maintenance organizations (HMOs) and fee-for-service (FFS).
A structured survey was administered to a cohort of 982 people with SLE who were assembled between 2002 and early 2005. A total of 2,656 person-years of observation were completed by the end of 2005. In each year, respondents reported their health care utilization and whether they had HMO or FFS coverage. We compared health care utilization of those in HMOs and FFS, with and without adjustment for socioeconomic, demographic, and health characteristics using repeated-measures regression techniques.
Compared with people with SLE who were in FFS, those in HMOs were younger (3.3 years), received a diagnosis at an earlier age (3.6 years), had slightly less disease activity (0.4 on a 10-point scale), were more likely to be nonwhite (8.8%), were less likely to be below the poverty line (7.8%), and were less likely to have public insurance (29.7%). The 2 groups did not differ in other characteristics. On an unadjusted basis, subjects with SLE in HMOs had significantly fewer physician visits (3.1; 95% confidence interval [95% CI] 1.7, 4.5) and were less likely to report one or more outpatient surgical visits (6.3%; 95% CI 2.5, 10.0), and hospital admissions (5.5%; 95% CI 1.7, 9.3) than those in FFS. Adjustment reduced the differences in physician visits (2.3; 95% CI 1.1, 3.5), outpatient surgical rates (4.4%; 95% CI 0.6, 8.1), and hospital admission rates (4.0%, 95% CI 0.4, 7.7).
Subjects with SLE in HMOs utilized substantially less ambulatory care and were less likely to have outpatient surgery and hospital admissions than those in FFS; the effects were not completely explained by socioeconomic, demographic, and health characteristics.