Dr. Lewak has properly raised a question concerning the comparison of hospital utilization data from the Oregon Kaiser Health Plan, which represents the practice of pediatricians, with hospital utilization data from the Kansas Blue Cross and Professional Activities Study, which reflects the practices of general practitioners and pediatricians. He cites two studies of lower respiratory infection which suggest to him that hospitalization of children is lower in a private pediatric group than in a prepaid health practice. Finally, he questions the use of provider record data for comparative utilization studies.
It is perhaps most useful to consider the question of utilization in different forms of medical practice from the viewpoint of the consumer. Recent regional data from the National Center for Health Statistics confirms that tonsillectomy rates as well as primary appendectomy rates are approximately 25% lower in the Oregon Kaiser Health Plan than in the more traditional forms of