BACKGROUND A commonly voiced concern is that health maintenance organizations (HMOs) may withhold or delay the provision of urgent, essential care, especially for vulnerable patients like the elderly. OBJECTIVE To compare the quality of emergency care provided in Minnesota to elderly patients with acute myocardial infarction (AMI) who are covered by HMO vs fee-for-service (FFS) insurance. M...

BACKGROUND: This study presents preliminary findings for the first nine months of the State of Colorado USA Medicaid capitation Pilot Project. Two different models of capitation (model I and model II) are compared with fee for service (FFS) in providing services to severely and persistently mentally ill adults. In model I the state's mental health authority contracts with community mental healt...

Prior research has shown that prescription drug spending grew substantially during the decade of the 1990s. This analysis uses 1996 to 1998 State Medicaid Research File (SMRF) fee-for-service (FFS) data for 29 participating States to provide insight into the factors driving this growth. The analysis examines cost variation by census region, State, Medicaid basis of eligibility, and therapeutic ...

We compared the health status of 863 health maintenance organization (HMO) enrollees with that of 4,576 non-enrollees, controlling for demographics and area of residence, using 1994 data from the Medicare Current Beneficiary Survey (MCBS). HMO respondents were less likely to report fair or poor health, functional impairment, or heart disease. Average predicted costs based on various health-stat...

In 1996, CMS launched the end stage renal disease (ESRD) managed care demonstration to study the experience of offering managed care to ESRD patients. This article analyzes the financial impact of the demonstration, which sought to assess its economic impact on the Federal Government, the sites, and the ESRD Medicare beneficiaries. Medicare's costs for demonstration enrollees were greater than ...

Yu-Ning Wong, MD, MSCE e-mail: [email protected]⇓ Fox Chase Cancer Center, Philadelphia, PA . In the article that accompanies this editorial, Malin et al use data from the Cancer Outcomes Research and Surveillance study (CanCORS) to measure the association between medical oncologists' compensation structure and their perception of whether their income will increase if they administer chemot...

This paper analyzes the role of referrals in the provision of surgical services. Primary physicians in managed care control patient access to specialists, while referrals in traditional insurance plans are less constrained. The traditional, fee-for-service insurance market is shown to achieve appropriate incentives for high quality care. In contrast, physicians with bad reputations may not lose...

Accountable care organizations (ACOs) have received significant attention since passage of the Patient Protection and Affordable Care Act (ACA) in the spring of 2010. The ACA directs the Secretary of the U.S. Department of Health and Human Services (DHHS) to create the Medicare Shared Savings Program, which encourages groups of providers (e.g., group practices, networks of individual practices,...

The authors thank Cairan Phibbs for generously providing data on neonatal intensive care units, and we thank seminar participants at the Abstract Most Americans are now in some form of managed care plan. These plans typically restrict access to providers and services in order to reduce costs. But it has been difficult to determine whether these restrictions affect necessary as well as unnecessa...

Should governments subsidize entry to promote competition? The US Medicare has increased its spending on private Medicare plans, based on the idea that they provide consumers more alternatives and enhance the program’s e¢ ciency. In this paper, I develop an empirical framework with endogenous entry to evaluate welfare consequences of such policy interventions with the data from 2003 and 2004. C...