caa a22 4500 397516959 CHVBK 20200916193720.0 cr unu---uuuuu 161202s1995 xx s 000 0 eng 10.1093/eurpub/5.3.157 doi (NATIONALLICENCE)oxford-10.1093/eurpub/5.3.157 Self-selection of enrollers at the creation of a managed care organization [Elektronische Daten] [JEAN-FRANÇOIS ETTER, THOMAS V. PERNEGER, ANDRÉ ROUGEMONT] Factors affecting choice between a managed care organization (MCO) and a fee-for-service insurance plan were examined when the University of Geneva health insurance plan was transformed into an MCO, in October 1992. A case-control study using a mailed questionnaire (response rate 84%) was conducted to compare former members who joined the MCO (joiners, n=421) to former members who opted out in order to keep fee-for-service coverage (non-joiners, n=222). Non-joiners were more likely to be women (odds ratio (OR) from multivariate model was 1.15, p=0.50), to be born in Switzerland (OR=2.04, p<0.01), to have an annual income >75,000 Swiss francs (OR=2.00, p<0.01), to have a personal physician (OR=1.96, p<0.01) and to have consulted a specialist (OR=1.69, p=0.02) or used unconventional medicine (OR=4.59, p<0.01) in the past year. During the previous year, non-joiners had more health care visits than joiners (14.6 versus 9.1, p=0.01). Non-joiners reported better mental health and fewer complained of persistent fatigue (OR=2.18, p=0.03). The choice of health plan was strongly influenced by socio-demographic characteristics, past patterns of health services utilization and health status. The self-selection process was paradoxical: MCO joiners had used fewer health care visits than non-joiners, but their self-reported health status was worse. The differences we have observed between self-selected populations have important implications for the financial performance of competing health care delivery systems. © European Journal of Public Health ORIGINAL ARTICLES nationallicence managed care organizations nationallicence selection process nationallicence health status nationallicence health services utilization nationallicence ETTER JEAN-FRANÇOIS Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut PERNEGER THOMAS V. Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut ROUGEMONT ANDRÉ Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut The European Journal of Public Health Oxford University Press 5/3(1995), 157-162 1101-1262 5:3<157 1995 5 eurpub https://doi.org/10.1093/eurpub/5.3.157 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-oxford NATIONALLICENCE 856 40 https://doi.org/10.1093/eurpub/5.3.157 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- ETTER JEAN-FRANÇOIS Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut NATIONALLICENCE 700 1- PERNEGER THOMAS V. Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut NATIONALLICENCE 700 1- ROUGEMONT ANDRÉ Institute of Social and Preventive Medicine, University of Geneva, Centre Médicine Universitaire, Genève, Switzerland aut NATIONALLICENCE 773 0- The European Journal of Public Health Oxford University Press 5/3(1995), 157-162 1101-1262 5:3<157 1995 5 eurpub