Dissertation Abstract

Health Maintenance Organizations (Hmos), National Committee On Quality Assurance (Ncqa) Accreditation Standards, and Public Interest Regulation

This study compared HMOs with and without NCQA accreditation, based on data gathered from the HCIA-Sachs HMO and NCQA Quality Compass databases, to determine if NCQA accreditation status was significantly related to an HMO's ability to perform in the areas of identified by the literature as public concerns. A review of the literature found that no substantive research had been undertaken to test the NCQA accreditation process for its fitness as a regulatory model with regard to its ability to address the concerns of the public. The literature identified as the public's main concerns HMO profit motive and limits placed on hospital and physician care. The literature also identified two organizational characteristics that might impact an HMO's decision to become accredited. Those characteristics were identified as HMO age and HMO size, in terms of total enrollment.

The study sample included 595 HMOs (N = 595). Each of the sample HMOs was cross-referenced with the NCQA Quality Compass database to determine the accreditation status of the each HMO. The sample was limited to HMOs for which the respective state departments of insurance required the disclosure of the variables under study (i.e., medical expense, administrative expense, total HMO revenue, beddays per 1,000 HMO enrollees, physician encounters per 1,000 enrollees, nonphysician encounters per 1,000 enrollees, HMO age, and HMO size). t tests found no significant differences between HMOs with and without NCQA accreditation with respect to the variables identified in the literature as public concerns or interests; however, significant relationships existed between NCQA accreditation status and HMO organizational characteristics studied (HMO age and HMO size). The study concluded with a summary of the findings and made suggestions for future research on the HMO industry and regulation in the public interest.

This dissertation citation and abstract are published with permission of ProQuest Information and Learning. Further reproduction is prohibited without permission.