Comments on Enthoven’s “The U.S. Experience with Managed Care and Managed Competition”

This session will provide an overview of the U.S. health care system with an emphasis on trends observed since the reforms of the early 1990s. ; How has the health care system adjusted to the introduction of market-oriented medicine? And what have been the consequences for access to care, health care costs (public and private), and the quality of care over the past decade? How does the U.S. health care system measure up in international comparisons, for instance? Does managed care work as its advocates expected or have inappropriate consumer and provider incentives undermined this experiment? What are the implications for reform?Health care reform

Quality and Employers' Choice of Health Plan

We seek to understand the relationship between employer decisions regarding which health plans firms choose to offer to their employees and the performance of those plans. We measure performance using data from the Health Plan Employer Data Information Set (HEDIS) and the Consumer Assessment of Health Plan Survey (CAHPS). We use a unique data set that lists the Health Maintenance Organizations (HMOs) available to, and offered by, large employers across markets in the year 2000, and examine the relationship between plan offerings, performance measures and other plan characteristics. We estimate two sets of specifications that differ in whether they model plan choice as a function of absolute plan performance or plan performance relative to competitors. We find that employers are more likely to offer plans with strong absolute and relative HEDIS and CAHPS performance measures. Our results are consistent with the view that large employers are responsive to the interests of their employees.

A New Medicare End-of-Life Benefit for Nursing Home Residents

A new Medicare benefit is needed to support end-of-life care for those spending their final days in a nursing home, say the authors of this article. Arguing that the current hospice benefit is a poor fit with the nursing home setting, the authors recommend a new benefit that would enable nursing home residents to receive individualized palliative and psychosocial services in addition to rehabilitative services

Charity Care, Risk Pooling, and the Decline in Private Health Insurance

Economic

HEDIS Measures and Managed Care Enrollment

This article examines the relationship between 1996 health plan enrollment and both HEDIS-based plan performance ratings and individual HEDIS measures. Data were obtained from a large firm that collected, aggregated, and disseminated plan performance ratings to its employees. Plan market share regressions are estimated controlling for out-of-pocket price and model type in addition to the plan ratings and HEDIS measures. The results suggest that employees did not respond strongly to the provided ratings. There are several potential explanations for the lack of response, including difficulty understanding the ratings and never having seen them. In addition, employees may base their plan choices on information that is obtained from their own past experience, friends, family, and colleagues. The pattern of results suggests that such information is important. Counterintuitive signs most likely reflect an inverse correlation between some HEDIS ratings (or measures) and attributes employees observe informally.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68992/2/10.1177_107755879905600204.pd

THE PHYSICIAN LABOR MARKET IN A MANAGED CARE-DOMINATED ENVIRONMENT

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74586/1/j.1465-7295.1999.tb01430.x.pd

Managed Care and Medical Expenditures of Medicare Beneficiaries

This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service enrollees. We find that increasing penetration leads to reduced health care spending on fee-for-service beneficiaries. In particular, a one percentage point increase in Medicare HMO penetration reduces such spending by .9 percent. We estimate similar models for various measures of health care utilization and find penetration-induced reductions, consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition.