The pediatric experience of an experimental prepaid group practice in a medical school setting

The Medical Care Group (MCG) of Washington University is an experimental prepaid group practice which operates as an integral part of a medical school. When the practice was begun, study (MCG) and control group (CG) families were enrolled and selected prospectively by random drawing. Medical care utilization by families in the prepaid group practice (MCG) then was compared with that of families cared for in the traditional fee-for-service system (CG). The data presented here represent pediatric utilization for the first 25 months' experience. There were 592 pediatric person years of experience (PY) in MCG and 697 PY in CG. MCG enrollees made almost twice as many ambulatory visits as did CG, 3.45 versus 1.79 visits/PY. There were fewer hospital admissions and the average duration of stay was shorter for MCG than for CG. Thus, MCG used 53.4% fewer hospital days 10.8 per 100 PY compared to 23.2 for CG (p = < 0.01). This reduction resulted more from reduced nonsurgical than surgical utilization. These data substantiate, in a prospectively controlled study of pediatric enrollees, the reduced hospital and increased ambulatory care utilization expected in a prepaid group practice and support the feasibility of conducting such a practice as an integral part of a medical school setting.