he success of managed care plans may be due to their apparent increased efficiency. HMOs use fewer health care resources to deliver a comparable quality of care. Surveys of HMOs generally show lower admission rates. In addition, HMO patients typically have shorter hospital lengths of stay, and fewer discretionary procedures or tests.
One method, in particular, by which HMOs reduce their health care expenditures involves the utilization of primary care. Although there is little definitive evidence with regard to the qualitative effects of substituting primary care for specialty care, many hospitals have adopted the "delivery model" (Bindman, 1994, pp. 78-81). Within these organizations, in-hospital physicians act as gatekeepers to allocate valuable health care resources.
According to an Institute of Medicine conference held in the late 1970s, the definition of primary care incorporates the following five components: Accessibility, accountability, comprehensiveness, continuity, and coordination. Accessibility involves service availability; whereas accoun
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