The diverse and continually changing medical scene in the United States, based historically on a free market model, has been accompanied by rapidly increasing costs, often at twice the rate of general inflation."2 Successive governments have vainly attempted to control these costs and have found it necessary to monitor quality of care as health care providers, faced in certain sectors with a de...

Background: Literature abounds with various techniques for efficiency measurement of health care organizations (HCOs), which should be used cautiously and appropriately. The present study aimed at discovering the rules regulating the interplay among the number of inputs, outputs, and decision- making units (DMUs) and identifying all methods used for the measurement of Iranian HCOs and criticall...

Advancing the health of the poor requires aligning a wide array of interests, all of which influence how health care is delivered. Global health professionals often face difficult decisions that can affect their working relationships with government officials, local colleagues, nongovernmental organizations (NGOs), and private sector interests. This article proposes a "compass-based" framework ...

Recently, the Department of Defense replaced its traditional fee-for-service insurance plan for military health care beneficiaries with an HMO/PPO hybrid. Using survey and claims data, we compare changes in costs over two years at sites that implemented this initiative (CRI) with changes at matched control sites. The results indicate that CRI substantially raised per beneficiary government cost...

Much evidence points to the fact that managed care plans (health maintenance organizations and preferred provider insurance) reduce costs and offer value for money. Yet they apparently have not helped to slow national health expenditures. One explanation is that the practices of purchasers (including government and employers), the tax laws, and other market imperfections have reduced the demand...

This DataWatch presents estimates of the health care costs for all adults who were continuously enrolled in a large staff-model health maintenance organization (HMO) during 1992. More than one-third of these adults were diagnosed with at least one chronic condition in 1992, and costs for this population are at least twice those of the population without chronic conditions. A diagnosis of a chro...

BACKGROUND Although numerous changes are apparent in the US health care system, little is known about how these changes have altered the work of primary care physicians. METHODS We analyzed a nationally representative sample of 136,233 adult office visits to general internists, general practitioners, and family physicians contained in the 1978 through 1981, 1985, and 1989 through 1994 Nationa...

The same forces that encouraged the expansion of managed care also brought about change in health maintenance organizations (HMOs). Using data from annual surveys of the Association of American Health Plans and other sources, this paper examines ten major changes in the HMO industry during the 1990s, including the growth of for-profit plans and the relative decline of nonprofits; the shift from...