The report found that HMO's and other managed care organizations vary greatly in terms of the amount of preventive care provided, treatment of acutely and chronically ill patients, access to care and member satisfaction. In nearly every measure, health plans in New England fared the best, while health plans in the South Central United States fared the worst. Research also confirms that insurance status appears to impact the services an individual patient receives. A study in the August 1996 issue of Medical Care found that, when physicians were given identical patient scenarios for insured and uninsured patients, they were more likely to recommend services for the insured population. The physicians recommended services for 72 percent of the insured patients, as compared to 67 percent of the uninsured.
Race can also be an important predictor.
Studies over the years have reported racial differences in the treatment of colorectal cancer, hysterectomies, kidney transplantation, some discretionary procedures and cardiac services. Recently, study results published in The New England Journal of Medicine found that blacks with coronary disease were significantly less likely than whites to have coronary revascularization, particularly coronary-artery bypass graft surgery, even after adjusting for disease severity and coexisting conditions. The differences in treatment were most pronounced among those likely to benefit most from the procedure. In an effort to improve clinical outcomes, the New York State Department of Health introduced report cards for coronary-artery bypass graft surgery in the early 1990's. The report cards provide data that allow physicians and patients to compare providers and have been used by providers to review their procedures and make improvements.