• who understand and accept the general limitations of an HMO still report problems, whose prevalence is not well documented but which can be grouped into four categories:
    • poor provider technical quality, such as thoroughness of exams (Rossiter et al., 1989);
    • poor provider interpersonal quality, such as unwillingness to discuss problems and explain diagnoses and treatments or lack of sympathy toward the patient (Rossiter et al., 1989; U.S. Department of Health and Human Services, 1995);
    • inconvenience, such as the time required to obtain an appointment or the time that one must wait on the phone or in the office (U.S. Department of Health and Human Services, 1995); and
    • access, including geographic proximity to offices, ability to see specialists, disputes over emergency care (in and out of the plan), and access to posthospital recovery and rehabilitation services or durable medical equipment (Dallek, 1995; Dallek et al., 1993; U.S. Department of Health and Human Services, 1995; U.S. General Accounting Office, 1995a).
  • Persons eligible for Medicare because of disability who disenroll from HMOs report considerably less satisfaction than elderly disenrollees on measures such as obtaining referrals to specialists or obtaining covered services, suggesting that HMOs may not all meet the needs of people with chronic illness and other serious health problems. Most disabled Medicare HMO enrollees report that they want to leave the HMO but are unable to do so because of inability to afford needed care under the fee-for-service system (Office of Inspector General, 1995).
  • Although fewer studies have attempted to discover what HMO enrollees really like about their plans that keep them enrolled, it appears that Medicare enrollees, like those in commercial plans, prefer HMOs for their cost containment and preventive orientation. They especially value additional services such as prescription drugs. They also seem to appreciate the opportunity that HMOs offer to coordinate care-the positive side of a gatekeeper requirement (Ferguson, 1995; Frederick/ Schneiders, Inc., 1995; Gibbs, 1995; Minnesota Health Data Institute, 1995; Rossiter et al., 1989).

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