Care of Chronically Ill Children ‘Disrupted’ by HMO Gatekeepers, Massachusetts General Hospital Study Finds

Chronically ill children visited specialists and primary care physicians less often after their parents joined HMOs with gatekeepers, a study conducted by Massachusetts General Hospital found. The Boston Herald reports that study researchers followed more than 1,800 children from 1991 to 1994, concentrating on those whose parents during that time either switched to an HMO with a gatekeeper or remained in a fee-for-service plan. "I can't say they got better or worse care, but I can say their care was disrupted," said Dr. Timothy Ferris, a pediatrician and lead author of the study, published in this month's issue of Pediatrics. Researchers had expected patients in HMOs with gatekeepers to receive increased amounts of care from their primary care providers, a theory contrary to the study's findings. But Dr. Mary Lou Buyse, president of a Massachusetts HMO industry group, said the findings are from "old data" and that the industry has "evolved" since the period during which the study was conducted. Chiding the study for "failing to measure managed care benefits such as education or guidance," Buyse noted that HMOs are now offering "more options that give patients flexibility" (Powell, Boston Herald, 8/7).