State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on government spending and health care quality is difficult if, as is often the case, recipients have the...

Over the last two decades, employers have increasingly offered workers a choice of health plans. The availability of choice has the potentially beneficial effects of lowering the cost and increasing the quality of health care through greater competition among health plans for enrollees as well...

During the 1990s US healthcare markets underwent a significant transformation. Managed care rose to become the dominant form of insurance in the private sector. Also, a wave of hospital consolidation occurred. In 1990, the mean population-weighted hospital Herfindahl-Hirschman Index (HHI) in a...

Managed care health insurers in the US restrict their enrollees' choice of hospitals to within specific networks. This paper considers the implications of these restrictions. A three-step econometric model is used to predict consumer preferences over health plans conditional on the hospitals...

Managed care activity may alter the incentives associated with the acquisition and use of new medical technologies, with potentially important implications for health care costs, patient care, and outcomes. This paper discusses mechanisms by which managed care could influence the adoption of new...

Medicaid is increasingly provided by private managed care plans. I investigate the staggered rollout of mandates across counties in New York, which required Medicaid beneficiaries to enroll in a private managed care plan. I find improvements following the mandate, as evidenced by increased...

Grundideen von Managed Care -- Grundzüge des amerikanischen Gesundheitssystems -- Neue Institutionenökonomie -- Managed-Care-Organisationen und -Produkte -- Managed-Care-Instrumente -- Evaluation von Versorgungskonzepten.

Das Buch stellt die Vielzahl unterschiedlicher Managed-Care-Organisationsformen und -Instrumente vor. Dabei wird detailliert sowohl auf Organisationsformen wie HMOs, PPOs, ACOs, PBM und andere eingegangen, als auch auf im Rahmen von Managed Care entstandene Vertragsmodelle. Neben den...

Improving global health outcomes amidst fiscal constraints, climate crises, and pandemics is a formidable challenge for governments worldwide. The recently published WHO/World Bank 2023 UHC Global Monitoring Report underscores a concerning reality: despite the goal of universal health coverage...

Chapter 1 Healthcare Systems of the World -- Chapter 2 Future of Health Care Delivery -- Chapter 3 Epidemiological Perspective of HC Management -- Chapter 4 Health Policy & Planning -- Chapter 5 Health Care Finance -- Chapter 6 Evaluating Health Systems -- Chapter 7 Health Care Needs Assessment...

Gesundheitspolitik ist angesichts der vielfältigen Herausforderungen an das deutsche Gesundheitssystem in aller Munde. Es erscheint notwendig, diesen Diskurs unter anderem auch aus einer ökonomisch-volkswirtschaftlichen Perspektive zu führen. Hauptanliegen dieses Lehrbuches ist es, die dafür...

Many observers have blamed HMOs for increasing financial pressures on private hospitals and causing them to cut back on the provision of charity care. We examine this issue using data on all hospital discharges in California between 1988 and 1996. We find that public hospitals in counties with...

Managed care may affect medical treatments for non-managed-care patients if it alters local market structure or physician behavior. We investigate whether higher levels of overall managed care market share are associated with greater use of recommended therapies for fee-for-service patients with...

The paper examines price discounting by health maintenance organizations and preferred provider organizations in markets for hospital services. Our empirical analysis focuses on transaction prices for angioplasty, which is a relatively common procedure, with well defined 'product'...

We use data on the enrollment decisions of federal annuitants to estimate the influence of publicizedratings on health plan choice. We focus on the impact of ratings disseminated by the NationalCommittee for Quality Assurance (NCQA), and use our estimates to calculate the value of...

This paper develops county-level estimates of HMO market share for all counties in the United States and uses them to examine the relationship between HMO market share and the fee for a normal office visit with an established patient charged by 2,845 fee-for-service (FFS) physicians. Two-stage...

In this study, we examine the effects of Medicaid managed care (MMC) on prenatal care utilization and infant health. We obtain separate estimates of the effect of primary care case management (PCCM) managed care programs and HMO managed care plans on prenatal care utilization, birth weight, and...

Increasing managed care activity could influence the adoption and diffusion of new medical technologies. This paper empirically examines the relationship between HMO market share and the diffusion of magnetic resonance imaging (MRI) equipment. Across markets, increases in HMO market share are...

Increases in the activity of managed care organizations are likely to have a number of implications for the structure and functioning of the US health care market. One possibility is that increases in managed care activity may have 'spillover effects,' influencing the performance of the entire...

We examine why managed care plans are less expensive than traditional indemnity insurance plans. Our database consists of the insurance experiences of over 200,000 state and local employees in Massachusetts and their families, who are insured in a single pool. Within this group, average HMO...

We examine the recent increase in hospital advertising expenditures. We first illustrate that the rise in hospital advertising has not been universal. Large, not-for-profit, teaching hospitals have, by far, experienced the largest increase in spending. Adjusting for size, for-profit hospitals...

Managed care health insurers in the US restrict their enrollees' choice of hospitals to specific networks. This paper investigates the causes and welfare effects of the observed hospital networks. A simple profit maximization model explains roughly 63 per cent of the observed contracts between...

We study the effect of physician incentives in an HMO network. Physician incentives are controversial because they may induce doctors to make treatment decisions that differ from those they would chose in the absence of incentives. We set out a theoretical framework for assessing the degree to...

We use data across states to examine the relation between HMO enrollment and medical spending. We find that increased managed care enrollment significantly reduces hospital cost growth. While some of this effect is offset by increased spending on physicians, we generally find a significant...

This paper is concerned with the economics of mental health. We argue that mental health economics is like health economics only more so: uncertainty and variation in treatments are greater; the assumption of patient self-interested behavior is more dubious; response to financial incentives such...

Most physicians today treat a variety of patients within their practices and operate in markets where a variety of insurance arrangements co-exist. In this paper, we propose several theoretical explanations for physician treatment patterns when the patient population is heterogeneous at the...

Because the optimal level of medical malpractice liability depends on the incentives provided by the health insurance system, the rise of managed care in the 1990s may affect the relationship between liability reform and defensive medicine. In this paper, we assess empirically the extent to...

In this paper we estimate the returns associated with the provision of coronary artery bypass graft (CABG) surgery, by payer type (Medicare, HMO, etc.). Because reliable measures of prices and treatment costs are often unobserved, we seek to infer returns from hospital entry behavior. We...

We use data from the National Health Interview Surveys to measure the effects of the growth of Medicaid managed care on children. We examine both the probability that individual children were Medicaid-covered and their utilization of care. We find that managed care penetration has significant...

Integrating the health services and insurance industries (HMOs) could lower expenditure by reducing either the quantity of services or unit price. We compare the treatment of heart attacks and newly diagnosed chest pain in HMOs and traditional plans in two data sets. The nature of these health...

By 1993, over 70% of all Americans with health insurance were enrolled in some form of managed care plan. The term managed care encompasses a diverse array of institutional arrangements, which combine various sets of mechanisms, that, in turn, have changed over time. The chapter reviews these...

We examine HMO participation and enrollment in the Medicare risk market for the years 1990 to 1995. We develop a profit- maximization model of HMO behavior, which explicitly considers potential linkages between an HMO's production decision in the commercial enrollee market and its participation...

Background: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service...

By 2022, the Indian healthcare industry is projected to rise to US$ 372 billion, powered by increased revenue, enhanced health literacy, lifestyle diseases and increased access to insurance. The healthcare industry is a significant and developing research context that can be defined by a strong...

Recently, not-for-profit health plans have been converting to for-profit status and these conversions have frequently occurred as steps to facilitate merger or acquisition with a for-profit company. Some industry observers attribute these managed care market place trends to an industry shake out...

Leveraging the random assignment of over 50,000 Medicaid enrollees in New York, I present causal evidence that narrow networks are a blunt instrument for reducing health care spending. While narrower networks constrain spending, they do so by generating hassle costs that reduce quantity, with...

The objective of this study is to estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. We use discharge data from the State of California for the period 1989-1993. The outcome variables are the risk-adjusted hospital...

Most existing studies of risk selection in the employer-sponsored health insurance market are case studies of a single employer or of an employer coalition in a single market. We examine risk selection in the employer-sponsored market by applying a switcher' methodology to a national, panel data...

This paper examines how the managerial labor market in nonprofit hospitals has adjusted to the negative income pressures created by HMO penetration. Using a panel of about 1500 nonprofit hospitals over the period 1992 to 1996, we find that top executive turnover increases following an increase...

Health plans paid by capitation have an incentive to distort the quality of services they offer to attract profitable and to deter unprofitable enrollees. We characterize plans' rationing as imposing a show that the profit maximizing shadow price depends on the dispersion in health costs, how...

We seek to investigate whether managed health care can affect mortality, and if so, through which mechanisms. We estimate the impact of Medicare+Choice (M+C), Medicare's managed care program, on elderly mortality, using a county-level panel from 1993 to 2000. We control for endogenous M+C...