Although the overall prevalence of HAART has increased since the mid-1990s, demographic disparities in HAART receipt persist. Our results support attempts to increase access to care and frequency of outpatient visits for underutilizing groups as well as increased efforts to reduce persistent disparities in women, African Americans, and injection drug users (IDUs).

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The effects of medical errors continue long after the patient leaves the hospital. Medical error studies that focus only on the inpatient stay can underestimate the impact of patient safety events by up to 20-30 percent.

Early reviews found that health maintenance organizations (HMOs) attracted healthier beneficiaries in the Medicare program and healthier employees in the market for employer-based insurance. This review finds that HMOs still attract healthier Medicare beneficiaries, that HMOs no longer attract healthier employees, and that HMOs attract healthier Medicaid recipients. This review also found conflicting evidence about whether Medicare HMOs are overpaid, no evidence that HMOs are overpaid in the market for employer-based insurance, and evidence that concerns about overpaying Medicaid HMOs have diminished because many states are adopting mandatory programs.

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This review examines the relationship between the financial incentives confronting physicians in managed care plans and the utilization of services. The primary conclusion of this review is that the financial incentives confronting physicians are a key element in explaining the lower utilization rates of enrollees in managed care plans. However, this conclusion is not definitive because it is based on studies that are subject to numerous sources of potential bias. To isolate the impact of financial incentives facing physicians on the performance of health plans, it is necessary to adjustor patient, physician, health plan, and market characteristics related to utilization, and most studies include little information about these characteristics.

This article reviews recent evidence about the relationship between managed care and quality. With one exception, the studies reviewed represent observation periods that extend through 1990 or a more recent year. The review has led to the conclusion that managed care has not decreased the overall effectiveness of care. However, evidence suggests that managed care may adversely affect the health of some vulnerable subpopulations. Evidence also suggests that enrollees in managed care plans are less satisfied with their care and have more problems accessing specialized services. In addition, younger, wealthier, and healthier persons were more satisfied with their health plans than older, poorer, and sicker persons, even after adjusting for the type of health plan.The findings of the studies reviewed do not provide definitive results about the effect of managed care on quality. Indeed, relatively few studies include data from the 1990s, and little is known about the newer types of health maintenance organizations that invest heavily in information systems and rely on financial incentives to alter practice patterns. Furthermore, managed care is not a uniform method that is applied identically by all health plans, and research studying the different dimensions of managed care also is needed.Arch Intern Med. 1998;158:833-841 In their 1994 review of managed care plan performance, Miller and Luft determined that: "The HMO [health maintenance organization] and indemnity plans provided enrollees with roughly comparable quality care, according to process or outcomes measures." 1(p1516) They also determined that HMO enrollees were less satisfied with their care than enrollees in indemnity plans.Miller and Luft 1 reviewed studies published before 1994. Yet, many important studies of the effect of managed care on quality have become available since that time. 2-9

Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.