You may have good reasons for hanging on to a health-insurance plan that lets you see any doctor you choose. Perhaps you want to stay with a physician you've been seeing for years, or maybe you like the freedom to see specialists without having to get permission from your primary-care physician.

But if you're paying more for a fee-for-service plan because you think it means better health care, don't count on it.A study reported on in a recent issue of the Journal of the American Medical Association showed "no evidence" that doctors who charge by the service provide consistently better care than those in managed-care systems. The study is the most comprehensive analysis to date of costs and outcomes for similar patients receiving care in different settings.

Patients with non-insulin-dependent diabetes or hypertension were seen in staff-model HMOs (where doctors are usually grouped in one building), in IPAs (prepaid plans in which doctors practice in their own offices) or by doctors in traditional fee-for-service plans. When researchers measured the status of patients' health after two and four years - and mortality rates after seven years - they found "no detectable differences" among the different systems.

Should you drop your current doctors and sign on with physicians in a less costly, prepaid plan? Not necessarily.

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As the study points out, more research is needed to show results for sicker patients.

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