Health Aff 10:140-154.
Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA
Differences between the health services utilization patterns of persons enrolled in health maintenance organizations (HMOs) and those receiving care under fee-for-service have been well documented.1 But unlike other aspects of care, there is little empirical evidence on the impact of HMOs on the use of prescription drugs.2 This relative lack of attention is due partly to the fact that pharmaceuticals account for less than 7 percent of U.S. health care expenditures and often represent an even smaller proportion of an HMO’s budget. However, “little-ticket” items can add up. In 1990, Americans spent an estimated $40 billion on prescription drugs and related expenditures.3 In addition, pharmaceuti- cals have importance beyond their expense. In the delivery of ambulatory medical care, medications are the most common of therapeutic modalities; over 60 percent of all physician visits result in a prescription.4 The use (or misuse) of medications can have profound implications for the patient and the system, in terms that are both clinical and economic.
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