HEALTH PROMOTION AND MANAGED CARE - SURVEYS OF CALIFORNIA HEALTH PLANS AND POPULATION

Introduction: The purpose was to examine whether health-promotion prog rams offered by California health plans are a serious attempt to impro ve health status or a marketing device used in an increasingly compete tive marketplace. The research examined differences in the coverage, a vailability, utilization, and evaluation of health-promotion programs in California health plans. Methods: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) li censed to sell comprehensive health insurance in California in 1996 (s ome plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 C alifornia Behavioral Risk Factor Survey (BRFS) of 4,000 adults was use d to estimate population participation rates in health-promotion progr ams. Results: California's HMOs in 1996 offered more comprehensive pre ventive benefits and health-promotion programs compared to PPO and ind emnity plans. HMOs relied on a more comprehensive set of health-educat ion methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likel y to have developed relationships with community-based and public heal th providers. Participation in health-promotion programs is low (2%-3% ), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HM Os, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. Conclusion: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of he alth improvement and cost control.