HEALTH SERVICES UTILIZATION AND ATTITUDES TOWARD HEALTH MAINTENANCE ORGANIZATIONS: A THEORETICAL AND METHODOLOGICAL DISCUSSION.

This paper has two primary purposes. The first involves the empirical assessment of a general framework for theory and research in health service utilization studies, developed as a modification of Aday and Andersen's (1974) causal structure of access to medical care. My analysis of this framework uses multiple regression techniques on data from a regional cross-sectional survey of 487 households conducted in 1972. The data demonstrate support for the general framework. The second purpose centers around the extant findings that health maintenance organization (HMO) subscribers are less satisfied with their health care than are the conventionally insured. Using the general framework to see what health service utilization characteristics were likely to predispose one to join an HMO, I found that would-be joiners are more likely to be high users of preventive services. Because the main purpose of the HMO is to increase the use of preventive services, and assuming a reasonable rate of diminishing returns of such care, then a "ceiling effect" takes place in which the would-be joiner cannot increase use of preventive care very much, and hence is plausibly and expectably less satisfied with the HMO. [ABSTRACT FROM AUTHOR]