Leveling the playing field: Managed care enrollment and hospital use, 1987-1996

Health Affairs

Volumn 19, Issue 3, 2000, Pages 178-184

  Weinick, Robin M ^a   Cohen, Joel W ^a  

^a Agy for Hlthcare Res and Quality   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; ARTICLE; CHILD; DEMOGRAPHY; FEMALE; HEALTH INSURANCE; HEALTH SERVICE; HOSPITAL; HUMAN; INFANT; MALE; MIDDLE AGED; PRESCHOOL CHILD; STATISTICS; UTILIZATION REVIEW;

ADOLESCENT; ADULT; CHILD; CHILD, PRESCHOOL; DEMOGRAPHY; FEMALE; HEALTH SERVICES NEEDS AND DEMAND; HOSPITALS; HUMANS; INFANT; MALE; MANAGED CARE PROGRAMS; MIDDLE AGED;

EID: 0004922246     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.3.178     Document Type: Article

References (21)

1. See, for example, H.S. Luft, Health Maintenance Organisations: Dimensions of Performance (New York: John Wiley and Sons, 1981); and R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980," Journal of the American Medical Association 271, no. 19 (1994): 1512-1519.
2. See, for example, H.S. Luft, Health Maintenance Organisations: Dimensions of Performance (New York: John Wiley and Sons, 1981); and R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980," Journal of the American Medical Association 271, no. 19 (1994): 1512-1519.
3. See, for example, A.K. Taylor, K.M. Beauregard, and J.P. Vistnes, "Who Belongs to HMDs: A Comparison of Fee-for-Senice versus HMO Enrollees," Medical Care Research and Review 52, no. 3 (1995): 389-408.
4. M. Freudenheim, "Employees Facing Steep Increases in Health Costs," New York Times, 27 November 1998, A1; and M. Freudenheim, "Humana Quarterly Charge Will Result in Loss in 1999," New York Times, 4 January 2000, C2.
5. M. Freudenheim, "Employees Facing Steep Increases in Health Costs," New York Times, 27 November 1998, A1; and M. Freudenheim, "Humana Quarterly Charge Will Result in Loss in 1999," New York Times, 4 January 2000, C2.
6. See, for example, D.R. Wholey et al., "HMO Market Structure and Performance: 1985-1995," Health Affairs (Nov/Dec 97): 75-84; C.G. McLaughlin, "HMO Growth and Hospital Expenses and Use: A Simultaneous-Equation Approach," Health Services Research 22, no. 2 (1987): 183-205; and J.C. Robinson, "Decline in Hospital Utilization and Cost Inflation under Managed Care in California," Journal of the American Medical Association 276, no. 13 (1996): 1060-1064.
7. See, for example, D.R. Wholey et al., "HMO Market Structure and Performance: 1985-1995," Health Affairs (Nov/Dec 97): 75-84; C.G. McLaughlin, "HMO Growth and Hospital Expenses and Use: A Simultaneous-Equation Approach," Health Services Research 22, no. 2 (1987): 183-205; and J.C. Robinson, "Decline in Hospital Utilization and Cost Inflation under Managed Care in California," Journal of the American Medical Association 276, no. 13 (1996): 1060-1064.
8. See, for example, D.R. Wholey et al., "HMO Market Structure and Performance: 1985-1995," Health Affairs (Nov/Dec 97): 75-84; C.G. McLaughlin, "HMO Growth and Hospital Expenses and Use: A Simultaneous-Equation Approach," Health Services Research 22, no. 2 (1987): 183-205; and J.C. Robinson, "Decline in Hospital Utilization and Cost Inflation under Managed Care in California," Journal of the American Medical Association 276, no. 13 (1996): 1060-1064.
9. For additional details, see W. Edwards and M. Berlin, Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives, D National Medical Expenditure Survey Methods 2 (Rockville, Md.: U.S. Public Health Service, September 1989; and J.W. Cohen et al., "The Medical Expenditure Panel Survey: A National Health Information Resource," Inquiry 33 (1996): 373-389.
10. For additional details, see W. Edwards and M. Berlin, Questionnaires and Data Collection Methods for the Household Survey and the Survey of American Indians and Alaska Natives, D National Medical Expenditure Survey Methods 2 (Rockville, Md.: U.S. Public Health Service, September 1989; and J.W. Cohen et al., "The Medical Expenditure Panel Survey: A National Health Information Resource," Inquiry 33 (1996): 373-389.
11. See www.hcfa.gov/facts/f9702b.htm (accessed 22 November 1999).
12. R.H. Miller and H.S. Luft, "Managed Care Plans: Characteristics, Growth, and Premium Performance," Annual Review of Public Health 15 (1994): 437-459. Also see AHRQ, MEPS HC-002, 1996 Panel Round I Parent Identifiers and HMO Data/Round 2 Health Status and Access to Care Data, Pub. no. 98-DP01 (October 1997), www.meps.ahrq.gov/pubdoc/hc002dc.pdf (accessed 22 November 1999).
13. R.H. Miller and H.S. Luft, "Managed Care Plans: Characteristics, Growth, and Premium Performance," Annual Review of Public Health 15 (1994): 437-459. Also see AHRQ, MEPS HC-002, 1996 Panel Round I Parent Identifiers and HMO Data/Round 2 Health Status and Access to Care Data, Pub. no. 98-DP01 (October 1997), www.meps.ahrq.gov/pubdoc/hc002dc.pdf (accessed 22 November 1999).
14. Jessica Banthin, AHRQ, personal conversation, 14 May 1999.
15. The difference in the types of plans included in our MCO measures may cause bias to be introduced into our across-time comparisons of MCO and non-MCO enrollees. If respondents included PPOs in their answers to the HMO enrollment question in both 1987 and 1996, then there will be no bias in comparisons across time. However, if respondents were more likely to include PPOs in their answers to the HMO question in 1996 than they were in 1987, then the biases introduced will depend on how PPOs are expected to behave. If PPOs behave like HMDs, no bias is introduced into our 1996 estimates. If PPOs behave more like FFS plans, comparisons of MCO and non-MCO enrollee hospital use would be biased toward zero because the HMO estimate would be closer to the FFS estimate. Although we cannot separate out HMOs from other types of managed care plans in our 1987 measure, when we restricted our MCO measure in 1996 to only those persons described by respondents as being enrolled in HMDs, there were virtually no differences in our results.
16. J. Gabel et al., "Growing Diversification in HMDs, 1988-1994," Medical Care Research and Review 54, no. 1 (1997): 101-117.
17. Standard error tables are available upon request from Robin M. Weinick, Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Suite 500, 2101 E. Jefferson Street, Rockville, Maryland 20852.
18. This figure derived from MEPS benchmarks well to the figure provided by the Health Care Financing Administration (HCFA): 42.8 percent of Medicaid-covered persons enrolled in MCOs from MEPS versus 40.1 percent from HCFA's administrative data. See HCFA, 1997 Mcdicaid Managed Care Enrollment Report (Baltimore, Md.: HCFA, 1998), www.hcfa.gov/medicaid/omchmpg.htm (accessed 22 November 1999).
19. These results suggest that there is little or no bias introduced into our estimates by including PPO and POS plans in the HMO variable in 1996. Such a bias would result in the HMO estimate rising toward the FFS level, rather than the FFS estimate declining, which is what we observe.
20. S. Guterman and A. Dobson, "Impact of the Medicare Prospective Payment System for Hospitals," Health Care Financing Review 7, no. 3 (1986): 97-114; and R.F. Coulam and G.L. Gaumer, "Medicare's Prospective Payment System: A Critical Appraisal," Health Care Financing Review (1991 Annual Supplement): 45-77.
21. S. Guterman and A. Dobson, "Impact of the Medicare Prospective Payment System for Hospitals," Health Care Financing Review 7, no. 3 (1986): 97-114; and R.F. Coulam and G.L. Gaumer, "Medicare's Prospective Payment System: A Critical Appraisal," Health Care Financing Review (1991 Annual Supplement): 45-77.