Women's health in HMOs: What we know and what we need to find out

Abstract

M anaged care, in general, and health maintenance organizations (HMOs), in particular, are growing rapidly and are now common mechanisms of health care delivery and financing in the United States. In 1994,51.1 million Americans were HMO members.’ Women in their childbearing years (age 15 through 44 years) are more likely to be HMO members than women of this age group in the general population.* Overall, the majority of HMO members are female. It is therefore critical that we understand how women receive health care in HMOs. In most HMOs, women choose their providers of reproductiverelated services. Alternatively, they may need referrals to different types of practitioners. HMOs provide varying levels of benefits, have different costsharing provisions, and offer different types of case-management. This paper examines what we know about how women who are HMO members receive their medical care and when possible compares their care with that of women enrolled in other types of insurance plans.