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Health Serv Res. 1986 February; 20(6 Pt 1): 659–682.
PMCID: PMC1068922

Factors affecting choice of health care plans.


The research reported here examined the factors which affected the decision to remain with either Blue Cross of Washington and Alaska or Group Health Cooperative of Puget Sound, or to change to an independent practice association (IPA) in which the primary care physicians control all care. The natural setting allowed examination of the characteristics of families with experience in structurally different plans; a decision not influenced by premium differentials; the importance of the role of usual provider; and a family-based decision using multivariate techniques. An expected utility model implied that factors affecting preferences included future need for medical care; access to care; financial resources to meet the need for care; and previous level of experience with plan and provider. Analysis of interview and medical record abstract data from 1,497 families revealed the importance of maintaining a satisfactory relationship with the usual sources of care in the decision to change plans. Adverse selection into the new IPA as measured by health status and previous utilization of medical services was not noted.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Moore SH, Martin DP, Richardson WC. Does the primary-care gatekeeper control the costs of health care? Lessons from the SAFECO experience. N Engl J Med. 1983 Dec 1;309(22):1400–1404. [PubMed]
  • Bice TW. Risk vulnerability and enrollment in a prepaid group practice. Med Care. 1975 Aug;13(8):698–703. [PubMed]
  • LANGNER TS. A twenty-two item screening score of psychiatric symptoms indicating impairment. J Health Hum Behav. 1962;3:269–276. [PubMed]
  • Berki SE, Penchansky R, Fortus RS, Ashcraft ML. Enrollment choices in different types of HMOs: a multivariate analysis. Med Care. 1978 Aug;16(8):682–697. [PubMed]
  • Scitovsky AA, McCall N, Benham L. Factor affecting the choice between two prepaid plans. Med Care. 1978 Aug;16(8):660–681. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust