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  • Title: Women's reproductive health services in health maintenance organizations.
    Author: Bernstein AB, Dial TH, Smith MD.
    Journal: West J Med; 1995 Sep; 163(3 Suppl):15-8. PubMed ID: 7571598.
    Abstract:
    Surveys were mailed to health maintenance organizations (HMOs) in February 1994, and the results of all questionnaires were compiled. Of 353 Group Health Association of America (GHAA) members, 236 (66.9%) responded. About 90% of HMOs covered insertion or removal of IUDs, oral contraceptives, and diaphragm fitting. Of these, 78% provided for levonorgestrel implant (Norplant) insertion or removal, and 70% covered at least some diaphragm charges. About 3/4 of the plans required some copayment for Pap tests, IUD insertion or removal, and diaphragm fitting; 67% for levonorgestrel implant insertion and removal; 58% for vasectomies; and 45% for tubal ligation. All HMOs surveyed covered mammography for women 50 years of age or older. Of group-model HMOs, 20% provided mammograms annually even to women between 35 and 40 years of age. Although all HMOs covered Pap tests, about 78% covered Pap tests annually and 18.5% covered them at the discretion of the provider as needed or less frequently than annually. About 88% of HMOs covered at least some abortions. 57% of HMOs responded that they covered abortions. Abortion coverage also varied by HMO model type. Although 75% of staff-model HMOs covered abortion services with no restrictions, only 48% of independent provider associations (IPA) did so. 81% of HMOs either offered enrollers the choice of an obstetrician-gynecologist as their primary care provider or allowed them to self-refer to one. This was true for 55% of staff-model HMOs. Of group and staff models that allowed self-referral, 87% had no restrictions on the number of self-referred obstetric-gynecologic visits per year, compared to 28% of network and IPA models. Certified nurse midwives more often provided routine services in staff models (43%), although they routinely performed pelvic and breast examinations less often in IPAs (20%). 14% of HMOs reported that they contracted with family planning organizations only for abortions, whereas 6% contracted for abortion and other services.
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