The United States should emulate the health care delivery methods of large prepaid group practices to improve care, Commonwealth Fund Senior Vice President Stephen C. Schoenbaum, M.D., argues in a Feb. 4 Health Affairs
article.Physicians and Prepaid Group Practices
is one of several perspectives on a Health Affairs study
that finds that large physician group practices serving three major HMOs operate with a physician-to-patient ratio up to 37 percent lower than the national rate. That analysis, prepared by Jonathan Weiner, deputy director of the Health Services Research and Development Center at the Johns Hopkins Bloomberg School of Health, raises questions about recent warnings of an imminent physician shortage in the United States.
Prepaid group practices (PGPs) are complex organizations that directly combine prepayment for health care with a comprehensive health care delivery system. As such, Schoenbaum says, their ability to manage physician staffing efficiently must be placed in context with the cost and quality of their care. Although PGPs are not likely to become the standard method of health care delivery in the United States, it should be possible to approach the care delivery goals that PGPs have set in the past by better integrating care through disease management programs and use of clinical information technology.
Schoenbaum's previously published "Employment of Physicians at Harvard Community Health Plan" (in From Physician Shortage to Patient Shortage,
Westview Press, 1986, and available for downloading at right) closely examines the physician employment practices in a large group model HMO.