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To the Editor: Dr Himmelstein and colleagues¹ correctly point out the potential for inaccuracies in their study of the differences between investor-owned and not-for-profit health maintenance organizations (HMOs). The Health Plan Employer Data and Information Set (HEDIS) reports, although prescriptive in method, are unaudited (a shortcoming since addressed by the National Committee for Quality Assurance [NCQA]). Also, the ability of health plans to obtain accurate data varies greatly. Even allowing for all of this, the primary conclusion of the article, that "investor-owned HMOs deliver lower quality of care than not-for-profit plans," would merit serious consideration and discussion.

However, to conclude that "the decade-old experiment with market medicine is a failure" is a bit of a stretch. The market is just beginning to understand the implications of reports such as the Quality Compass, but has not had adequate opportunity to react in a rational way to such information. The conclusion that, . . . [Full Text of this Article]

RELATED ARTICLE

Quality of Care in Investor-Owned vs Not-for-Profit HMOs
David U. Himmelstein, Steffie Woolhandler, Ida Hellander, and Sidney M. Wolfe
JAMA. 1999;282(2):159-163.
ABSTRACT | FULL TEXT