Deterrents to Family Enrollment in a Prepaid Group Practice

Research suggests that there are three prime deterrents to enrollment for persons who are attracted to prepaid group practice (PGP): 1) reluctance to change imbedded habits; 2) low expected utilization (low risk); and 3) payment for health insurance through employment. This study tests the influence of these enrollment barriers by examining families of new PGP members who are grouped according to whether their family members joined (FP) or remained outside (IP) the PGP under examination. The two groups of families do not differ in health status or past utilization as proxies of expected use of medical services. They do, however, differ according to the presence of a regular source of care. Although more IP than FP families report prior physician ties, the influence of this factor is diminished when other family characteristics are accounted for in a multivariate analysis. The variables explaining the most variance in enrollment type are family size, employment status and income. IP families are typically small (often without children), have two employees and a low adjusted family income. Although many PGPs have attempted to attract this family type through multitiered rate systems, it is doubtful that this approach can be effective in the long run. The broad practice of job-centered health insurance provides these families no systematic mechanism for combining their employee benefits to purchase a family plan and therefore little incentive to join a PGP family plan. Changes in the way health insurance is obtained are encouraged.