HMO data systems in population studies of access to care

Abstract

Objectives: A review of the current status of HMO data sets and their applicability to population studies of access to care.

Data sources: Publications and reports based on research among different models of HMOs; reviews of HMO quality of care by national organizations; and HMO industry profiles.

Study design: Design was a literature review of the content of HMO data sets: completeness of reporting, processing, and reporting.

Data collection: Publications and publicly available reports were reviewed.

Principal findings: Most HMOs are able to aggregate the number of services provided but demonstrate little ability to provide patient profiles. While their content is limited, HMO data sets are significant improvements over indemnity plan data, and where available, their accuracy in measuring health services utilization is superior to that of surveys. There are important differences among HMO delivery systems in their ability to provide useful data for population studies.

Conclusions: A valuable resource, HMO data are limited by their content and the relative inaccessibility to IPAC-HMO information. This could be improved through new financial and technical support to HMOs interested in research.