The future of managed care organization

Health Affairs

Volumn 18, Issue 2, 1999, Pages 7-24

  Robinson, James C ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMIC ASPECT; ECONOMICS; FORECASTING; HEALTH INSURANCE; HEALTH SERVICE; HEALTH SERVICES RESEARCH; HUMAN; ORGANIZATION AND MANAGEMENT; UNITED STATES;

ECONOMIC COMPETITION; FORECASTING; HEALTH SERVICES NEEDS AND DEMAND; HEALTH SERVICES RESEARCH; HUMANS; MANAGED CARE PROGRAMS; UNITED STATES;

EID: 0007473050     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.2.7     Document Type: Article

References (33)

1. J. Maxwell et al., "Managed Competition in Practice: 'Value Purchasing' by Fourteen Employers," Health Affairs (May/June 1998): 216-226; J. Christianson et al., "Managed Care in the Twin Cities: What Can We Learn?" Health Affairs (Summer 1995): 114-130; and J.C. Robinson, "Health Care Purchasing and Market Changes in California," Health Affairs (Winter 1995): 117-130.
2. J. Maxwell et al., "Managed Competition in Practice: 'Value Purchasing' by Fourteen Employers," Health Affairs (May/June 1998): 216-226; J. Christianson et al., "Managed Care in the Twin Cities: What Can We Learn?" Health Affairs (Summer 1995): 114-130; and J.C. Robinson, "Health Care Purchasing and Market Changes in California," Health Affairs (Winter 1995): 117-130.
3. J. Maxwell et al., "Managed Competition in Practice: 'Value Purchasing' by Fourteen Employers," Health Affairs (May/June 1998): 216-226; J. Christianson et al., "Managed Care in the Twin Cities: What Can We Learn?" Health Affairs (Summer 1995): 114-130; and J.C. Robinson, "Health Care Purchasing and Market Changes in California," Health Affairs (Winter 1995): 117-130.
4. See, for example, M.R. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," New England Journal of Medicine 333, no. 23 (1995): 1678-1683; S.M. Shortell, R.R. Gillies, and D.A. Anderson, "The New World of Managed Care: Creating Organized Delivery Systems," Health Affairs (Winter 1994): 46-64; and J.C. Robinson and L.P. Casalino, "Growth of Medical Groups Paid through Capitation in California," New England Journal of Medicine 313, no. 25 (1995): 1684-1687.
5. See, for example, M.R. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," New England Journal of Medicine 333, no. 23 (1995): 1678-1683; S.M. Shortell, R.R. Gillies, and D.A. Anderson, "The New World of Managed Care: Creating Organized Delivery Systems," Health Affairs (Winter 1994): 46-64; and J.C. Robinson and L.P. Casalino, "Growth of Medical Groups Paid through Capitation in California," New England Journal of Medicine 313, no. 25 (1995): 1684-1687.
6. See, for example, M.R. Gold et al., "A National Survey of the Arrangements Managed-Care Plans Make with Physicians," New England Journal of Medicine 333, no. 23 (1995): 1678-1683; S.M. Shortell, R.R. Gillies, and D.A. Anderson, "The New World of Managed Care: Creating Organized Delivery Systems," Health Affairs (Winter 1994): 46-64; and J.C. Robinson and L.P. Casalino, "Growth of Medical Groups Paid through Capitation in California," New England Journal of Medicine 313, no. 25 (1995): 1684-1687.
7. S.M. Butler and R.E. Moffit, "The FEHBP as a Model for a New Medicare Program," Health Affairs (Winter 1995): 47-61.
8. Shortell et al., "The New World of Managed Care;" J.C. Robinson, "Consolida-tion of Medical Groups into Physician Practice Management Organizations," Journal of the American Medical Association 279, no. 2 (1998): 144-149; and J.C. Robinson, "Financial Capital and Intellectual Capital in Physician Practice Management," Health Affairs (July/August 1998): 53-74.
9. Shortell et al., "The New World of Managed Care;" J.C. Robinson, "Consolida-tion of Medical Groups into Physician Practice Management Organizations," Journal of the American Medical Association 279, no. 2 (1998): 144-149; and J.C. Robinson, "Financial Capital and Intellectual Capital in Physician Practice Management," Health Affairs (July/August 1998): 53-74.
10. E.A. Kerr et al., "Managed Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization?" Annals of Internal Medicine 123, no. 7 (1995): 500-504; E.A. Kerr et al., "Quality Assurance in Capitated Groups: Where Is the Emphasis?" Journal of the American Medical Association 275, no. 15 (1996): 1236-1239; and Robinson and Casalino, "Growth of Medical Groups Paid through Capitation in California."
11. E.A. Kerr et al., "Managed Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization?" Annals of Internal Medicine 123, no. 7 (1995): 500-504; E.A. Kerr et al., "Quality Assurance in Capitated Groups: Where Is the Emphasis?" Journal of the American Medical Association 275, no. 15 (1996): 1236-1239; and Robinson and Casalino, "Growth of Medical Groups Paid through Capitation in California."
12. E.A. Kerr et al., "Managed Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization?" Annals of Internal Medicine 123, no. 7 (1995): 500-504; E.A. Kerr et al., "Quality Assurance in Capitated Groups: Where Is the Emphasis?" Journal of the American Medical Association 275, no. 15 (1996): 1236-1239; and Robinson and Casalino, "Growth of Medical Groups Paid through Capitation in California."
13. Details and data are available at www.healthscope.org.
14. For information on the provider credentialing program, see www.ncqa.org.
15. Some HMOs continue to contract with individual physicians on a fee-for-service basis and retain utilization review in house, rather than contracting with physician organizations on a capitation basis and delegating utilization management.
16. Power theories, according to which firms with significant economic and political assets cannot be displaced even if they lack production efficiency and sensitivity to consumers' preferences, do offer high explanatory power in contexts where competition has been eliminated or severely constricted by regulation. In such contexts, political connections and perceived institutional legitimacy play predominant roles in ensuring organizational success.
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18. M.C. Jensen and W.H. Meckling, "Theory of the Firm: Managerial Behavior, Agency Costs, and Ownership Structure," Journal of Financial Economics 3, no. 7 (1976): 305-360; and E.F. Fama and M.C. Jensen, "Agency Problems and Residual Claims," Journal of Law and Economics (June 1983): 327-349.
19. P.R. Milgrom, "Employment Contracts, Influence Activities, and Efficient Organizational Design," Journal of Political Economy 96, no. 1 (1988): 42-60; and H. Hansmann, The Ownership of Enterprise (Cambridge, Mass.: Harvard University Press, 1996).
20. P.R. Milgrom, "Employment Contracts, Influence Activities, and Efficient Organizational Design," Journal of Political Economy 96, no. 1 (1988): 42-60; and H. Hansmann, The Ownership of Enterprise (Cambridge, Mass.: Harvard University Press, 1996).
21. R. Eccles, The Transfer Pricing Problem: A Theory for Practice (Lexington, Mass.: Lexington Books, 1985); and J. Rotenberg, "A Theory of Inefficient Intrafirm Transactions," American Economic Review 81, no. 1 (1991): 191-201.
22. R. Eccles, The Transfer Pricing Problem: A Theory for Practice (Lexington, Mass.: Lexington Books, 1985); and J. Rotenberg, "A Theory of Inefficient Intrafirm Transactions," American Economic Review 81, no. 1 (1991): 191-201.
23. J.C. Panzar and R.D. Willig, "Economies of Scope," American Economic Review 71, no. 2 (1981): 268-272; D.J. Teece, "Economies of Scope and the Scope of the Enterprise," Journal of Economic Behavior and Organisation 1, no. 3 (1980): 223-247; and A.D. Chandler, Scale and Scope: The Dynamics of Industrial Capitalism (Cambridge, Mass.: Harvard University Press, 1990).
24. J.C. Panzar and R.D. Willig, "Economies of Scope," American Economic Review 71, no. 2 (1981): 268-272; D.J. Teece, "Economies of Scope and the Scope of the Enterprise," Journal of Economic Behavior and Organisation 1, no. 3 (1980): 223-247; and A.D. Chandler, Scale and Scope: The Dynamics of Industrial Capitalism (Cambridge, Mass.: Harvard University Press, 1990).
25. J.C. Panzar and R.D. Willig, "Economies of Scope," American Economic Review 71, no. 2 (1981): 268-272; D.J. Teece, "Economies of Scope and the Scope of the Enterprise," Journal of Economic Behavior and Organisation 1, no. 3 (1980): 223-247; and A.D. Chandler, Scale and Scope: The Dynamics of Industrial Capitalism (Cambridge, Mass.: Harvard University Press, 1990).
26. O.E. Williamson, The Economic Institutions of Capitalism (New York: Free Press, 1985); and M.K. Perry, "Vertical Integration: Determinants and Effects," in Handbook of Industrial Organization, vol. 1, ed. R. Schmalensee and R.D. Willig (New York: North Holland, 1989).
27. O.E. Williamson, The Economic Institutions of Capitalism (New York: Free Press, 1985); and M.K. Perry, "Vertical Integration: Determinants and Effects," in Handbook of Industrial Organization, vol. 1, ed. R. Schmalensee and R.D. Willig (New York: North Holland, 1989).
28. G.J. Stigler, "The Division of Labor Is Limited by the Extent of the Market," Journal of Political Economy 59, no. 3 (1951): 185-193; and A.D. Chandler, The Visible Hand: The Managerial Revolution in American Business (Cambridge, Mass.: Harvard University Press, 1977). 16. B. Klein, R.G. Crawford, and A.A. Alchian, "Vertical Integration, Appropriable Rents, and the Competitive Contracting Process," Journal of Law and Economics (October 1978): 297-326; and Williamson, The Economic Institutions of Capitalism.
29. G.J. Stigler, "The Division of Labor Is Limited by the Extent of the Market," Journal of Political Economy 59, no. 3 (1951): 185-193; and A.D. Chandler, The Visible Hand: The Managerial Revolution in American Business (Cambridge, Mass.: Harvard University Press, 1977). 16. B. Klein, R.G. Crawford, and A.A. Alchian, "Vertical Integration, Appropriable Rents, and the Competitive Contracting Process," Journal of Law and Economics (October 1978): 297-326; and Williamson, The Economic Institutions of Capitalism.
30. G.J. Stigler, "The Division of Labor Is Limited by the Extent of the Market," Journal of Political Economy 59, no. 3 (1951): 185-193; and A.D. Chandler, The Visible Hand: The Managerial Revolution in American Business (Cambridge, Mass.: Harvard University Press, 1977). 16. B. Klein, R.G. Crawford, and A.A. Alchian, "Vertical Integration, Appropriable Rents, and the Competitive Contracting Process," Journal of Law and Economics (October 1978): 297-326; and Williamson, The Economic Institutions of Capitalism.
31. G.J. Stigler, "The Division of Labor Is Limited by the Extent of the Market," Journal of Political Economy 59, no. 3 (1951): 185-193; and A.D. Chandler, The Visible Hand: The Managerial Revolution in American Business (Cambridge, Mass.: Harvard University Press, 1977). 16. B. Klein, R.G. Crawford, and A.A. Alchian, "Vertical Integration, Appropriable Rents, and the Competitive Contracting Process," Journal of Law and Economics (October 1978): 297-326; and Williamson, The Economic Institutions of Capitalism.
32. R. Vietor, Contrived Competition (Cambridge, Mass.: Harvard University Press, 1994).
33. If the acquisition of BlueCross BlueShield of Georgia is consummated, as planned, WellPoint will use the name BlueCross BlueShield rather than Unicare in Georgia.