VARIATIONS IN RESOURCE UTILIZATION AMONG MEDICAL SPECIALTIES AND SYSTEMS OF CARE

As sweeping changes in the organization and delivery of health care ar e implemented, it is important to examine the relationship between var ious types of cost-containment efforts, health care costs, and quality of care. This article reviews the evidence that physician specialty t raining, the organization of physicians, and the method of physician p ayment are significant influences upon the utilization of health care services. Data from before the late 1980s raised the possibility that family practitioners employed fewer resources than general internists and that health maintenance organizations used fewer resources than so lo practitioners. However, the studies from which these data were deri ved were marred by insufficient attention to patient mix, failure to a ccount for interactions between specialty and system, and inadequate r egard for the complexities of modern practice structures. More recent data from the Medical Outcomes Study (MOS) overcomes some but not all of these problems. In general, it can be safely concluded that primary care specialty training, group practice, and prepaid care are associa ted with less utilization. Nevertheless, much more research is needed to address remaining methodologic problems and to obtain data that are generalizable to the wide array of modern practice settings.