Do HMOs Affect Educational Disparities in Health Care?

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BACKGROUND: We wanted to examine how membership in a health maintenance organization (HMO) is related to delivery of preventive clinical services to patients with different educational levels. METHODS: We conducted a cross-sectional analysis of the 1996-1997 Community Tracking Study Household Survey among adults aged 18 to 64 years with private or Medicaid health insurance. We examined interactions between respondent educational level and HMO membership for the following measures: having a regular source of care and, in the past year, having had a physician visit, a mental health visit, a mammogram (women > or = 50 years), an influenza vaccination (ages > or = 55 years), or smoking cessation counseling (smokers). RESULTS: After adjustment for sociodemographic factors, community size, insurance type, physical and mental health status, and smoking, respondents with less education were significantly less likely to have had a physician visit or mental health visit, mammogram, or influenza vaccination in the past year. Disparities in receipt of preventive care by educational level were smaller among HMO members. Differences in disparities between HMO members and non-HMO members reached statistical significance for influenza vaccination and showed a trend for mental health visits (P = .06). Moreover, HMO members with less than 12 years of education received services at levels comparable to non-HMO members with more education. CONCLUSIONS: There are appreciable disparities in receipt of preventive care by education among nonelderly insured persons. HMO membership is associated with smaller disparities for some services. Those with the lowest levels of education appeared to benefit the most from HMO membership.

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