Immunology: Live T Cell Action in Lymph Nodes: Dating, Mating, Procreating Ophthalmology: Mechanism Found for Rare Vision Defect Health Policy: For-profit Health Plans Appear Not to Restrict High-cost Care Neurology: Faulty Membrane Repair May lead to Muscular Dystrophy Genomics: Center for RNA Interference Probes Fly Genome Imaging: Brain Takes Similar Approach to Bodily, Facial Expressions   Structure Traces Steps in Dengue Virus Infection A Back-end Attack Against Alzheimer's Plaque   Proceedings of the HMS Faculty Council Appointments to Full and Named Professorships HSPH Receives $6 Million Grant to Eliminate Health Disparities Elston Wins HSPH Biostatistics Award Milestone Symposium to Celebrate Civil Rights Honors and Advances   The Family Van: Care and Research on Wheels   Toward Redistributing Health Care Costs   Front Page

HEALTH POLICY For-profit Health Plans Appear Not to Restrict High-cost Care The conventional wisdom that for-profit health plans bolster their bottom line by denying patients expensive treatments was put to the test by HSPH researchers, with surprising results. When it came to high-cost surgical procedures, from coronary artery bypass to total hip and knee replacement, for-profit health plans provided as many or more operations to Medicare patients as not-for-profit plans. "We had expected that pressure to produce profits for investors in for-profit health plans would lead them to restrict use of high-cost procedures by enrollees, but our results suggest that this is not the case." --Eric Schneider "We had expected that pressure to produce profits for investors in for-profit health plans would lead them to restrict use of high-cost procedures by enrollees, but our results suggest that this is not the case," said Eric Schneider, HSPH assistant professor of health policy and management and lead author on the study, published in the Jan. 8 New England Journal of Medicine. Schneider, along with Arnold Epstein, chairman of the Department of Health Policy and Management, and statistician Alan Zaslavsky, HMS professor of health care policy, looked at 12 high-cost surgical procedures among almost 4 million Medicare patients in 254 health plans during 1997. Contrary to expectation, they found that for-profit plans had higher rates of carotid artery clearing, cardiac catheterization, coronary artery bypass, and angioplasty. The rates of other types of surgery, including hip and knee replacements, gall bladder removal, and hysterectomy, were similar in for-profit and not-for-profit plans. Even after adjusting for variables such as patient demographics, health plan characteristics, and geographical differences in surgical rates, the conclusions did not change: none of the procedures was performed less frequently in the for-profit plans than in the not-for-profit plans. Until recently, only limited data have been available to compare the use of procedures in different managed care plans. Since 1997, the federal government has required all health plans that enroll Medicare beneficiaries to report the use of these 12 high-cost procedures to the Center for Medicare Services. Schneider and his colleagues succeeded in linking the reported data from 1997 with demographic information about individual patients and their health plans. The study does not reveal why for-profit health plans have not reduced high-cost procedures to bring their rates in line with those of not-for-profit plans. The researchers speculate that for-profits may look for cost savings elsewhere or that not-for-profits and for-profits alike use similar approaches to save money, resulting in similar use of these particular high-cost services. This type of study does not indicate whether the use rate of these procedures is too high, too low, or just right. Today, most people in managed care are in for-profit plans, a reversal of the situation just 10 years ago, when only 25 percent were in for-profit managed care. Among Medicare clients, 15 percent, or about 4.5 million people, are in managed care plans. Schneider said, based on this study, seniors considering enrolling in health plans in the wake of recent Medicare legislation can choose a for-profit plan without worrying about restricted surgical choices. While the study involved only Medicare patients over age 65, Schneider expects he would see the same result with the general population. "Fears that for-profit ownership of health plans will lead to unreasonable restrictions on high-cost procedures may not be justified," he said. "On the other hand, our results also raise questions about whether for-profit health plans will be any more effective than not-for-profit plans at controlling health care spending." The study was funded by grants from the Commonwealth Fund and the Agency for Healthcare Research and Quality. --Pat McCaffrey