August 10, 2001

Parents of children with chronic conditions are not likely to choose an HMO plan, according to a study by MGH researchers. The report, in the August issue of Pediatrics, suggests these parents are willing to pay higher costs for medical care to have direct access to specialists.

"This study adds one more piece of evidence that people with chronic conditions avoid changing health plans," says lead author Timothy G. Ferris, MD, (right) a pediatrician for MassGeneral Hospital for Children. Although other studies have shown that adults with chronic conditions are less likely to switch plans, this study showed that a child's health status matters when parents are choosing a health plan.

From 1991 to 1994, the study followed more than 1,800 children whose parents either voluntarily switched to a "gatekeeping" HMO – one that requires that a primary care physician pre-approves visits to specialists – or remained in an indemnity plan, which provided unlimited patient access to specialists. The results showed that parents of children with chronic health conditions were significantly less likely than other parents to enroll in the gatekeeping plan.

The current study also questions the claim that HMO plans lower costs while improving delivery of care, since those children who had coverage through a gatekeeping plan had fewer visits both to specialists and to their primary care physicians.

Co-authors of the study, which was conducted under the auspices of the MGH Institute for Health Policy, were James Perrin, MD; Jennifer Manganello, MPH; Yuchiao Chang, PhD; Nancyanne Causino, EdD; and David Blumenthal, MD, MPP.