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Give a Hand for HMOs

Who goes to the doctor and what do they go for? Insurance companies and managed care companies use this information to plan services. When it comes to orthopedic services, back pain tops the list of musculoskeletal problems. After that comes arthritis, traumatic injuries, and knee and shoulder problems.

Only about one in 10 patients is seen for a wrist or hand problem. The most common wrist or hand problems are fractures, carpal tunnel syndrome, tendonitis, and cysts. About half of those patients needed surgery.

These are the results of a study looking at how often members of a capitated insurance plan are treated for a specific body region. (Capitated means a single fee per person is paid to the doctor or clinic.) This type of plan is called a health maintenance organization (HMO). The same amount of money is paid to the HMO whether you see the doctor (or other health care provider) 100 times a month or not at all.

Researchers who conducted this study also looked at how gender and age are linked to services used by patients. They found use of services for arthritis increased as patients (especially women) got older, starting at age 35. Wrist and hand problems caused by trauma decreased with age after age 35. Men are more likely to be treated for injuries. Children from birth to 15 use orthopedic services the most for hand and wrist conditions.

Knowing how much demand there is for a type of service or doctor helps HMOs plan ahead. They can tell how many doctors they'll need and what kind of training those doctors must have to work in the HMO. The information also helps doctors negotiate contracts and fee schedules with the HMO.


C. Craig Crouch, MD, et al. Utilization of Orthopaedic Services for Hand and Wrist Conditions in a Capitated Population. In The Journal of Bone and Joint Surgery. January 2004. Vol. 86-A. No. 1. Pp. 51-56.

03/15/2004

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
All content provided by eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C.. Content is the sole property of Medical Multimedia Group, LLC and used herein by permission.

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