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Reports of aggressive marketing, confusion by seniors and physicians refusing to see patients enrolled in private fee-for-service plans gave the product"a black eye," said Calabrese.
All representatives selling products on behalf of a plan sponsor will have to pass a written test demonstrating familiarity with Medicare and fee-for-service plans.
Some HMOs scored poorly (but) enrollees rated many HMOs higher than traditional fee-for-service plans in several health care markets,'' said Dennis Becker, a Medstat vice president.
One of the largest insurers in the program, the Government Employees Health Association, offers a fee-for-service plan for single individuals at a cost of $2,548 a year ($212 per month), including both the employee's and the government's share.
The study found that elderly people and poor people who are chronically ill "were more than twice as likely to decline in health in an HMO" than in a fee-for-service plan.
As a result, the share of health care participants covered by fee-for-service plans has declined.
Thus it is important to understand how service use differs between prepaid and fee-for-service plans, especially for the sickest patients, who have the greatest need for care.
Another management issue for physician groups is comparing the profitability of HMO plans to not only each other, but also to other types of plans, including fee-for-service plans.
All fee-for-service plans enjoyed the same proportion of medically appropriate service use (judged by two physicians blind to patient plan).
The Clinton administration's health care reform bill proposes three types of health care plans, health maintenance organizations (HMOs), preferred provider organizations (PPOs) and the traditional fee-for-service plans (FFS).
Fee-for-service plans (also called indemnity plans): Plans that permit the patient to seek care from any provider, whose bill is then submitted to the insurer for payment under the terms required by the insurer.
The GHAA data predict that the number of people choosing HMOs could reach 50 million by the end of this year, including many consumers who will be switching from old-style fee-for-service plans.