Managed care and medicare reform

Journal of Health Politics, Policy and Law

Volumn 22, Issue 2, 1997, Pages 595-631

  Oberlander, Jonathan B ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

CHRONIC DISEASE; COST CONTROL; COST EFFECTIVENESS ANALYSIS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH ECONOMICS; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; MANAGED CARE; MEDICARE; QUALITY CONTROL; REVIEW; UNITED STATES;

CHRONIC DISEASE; COST SAVINGS; FORECASTING; HEALTH CARE REFORM; HUMANS; INSURANCE, HEALTH; MANAGED CARE PROGRAMS; MEDICARE; PRIVATE SECTOR; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 0030971620     PISSN: 03616878     EISSN: None     Source Type: Journal    
DOI: 10.1215/03616878-22-2-595     Document Type: Article

References (100)

1. Aaron, H. J. and R. D. Reischauer. 1995. The Medicare Reform Debate: What Is the Next Step? Health Affairs 14(4):8-30.
2. Anders, G. 1996. Medicare HMOs Get Fewer Complaints. Wall Street Journal, 14 March, p. B5.
3. Bipartisan Commission on Entitlement Reform. 1994. Staff Report on Entitlement Reform Options. Washington, DC.
4. Bodenheimer, T. S., and K. Grumbach. 1995. Understanding Health Policy. Norwalk, CT: Appleton and Lange.
5. Brown, L. D. 1983. Politics and Health Care Organization: HMOs as Federal Policy. Washington, DC: Brookings Institution.
6. Brown, R. S., D. G. Clement, J. W. Hill, S. M. Retchin, and J. W. Bergeron. 1993. Do Health Maintenance Organizations Work for Medicare? Health Care Financing Review 15(1):7-23.
7. Brown, R. S., and J. W. Hill. 1994. The Effects of Medicare Risk HMOs on Medicare Costs and Service Utilization. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
8. Buchmueller, T. C., and P. J. Feldstein. 1995. The Effect of Price on Switching among Health Plans. Working paper, Graduate School of Management, University of California, Irvine.
9. Butler, S. M., and R. E. Moffit. 1995. The FEHBP as a Mode for a New Medicare Program. Health Affairs 14(4):47-61.
10. Carlisle, D. M., A. L. Siu, E. B. Keeler, E. A. McGlynn, K. L. Kahn, L. V. Rubenstein, and R. H. Brook. 1992. HMO vs. Fee-for-Service Care of Older Persons with Acute Myocardial Infarction. American Journal of Public Health 82:1626-1630.
11. Christianson, J. B. 1994. Responses and Discussions: Premium Levels. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
12. Claxton, G., and L. Levitt. 1996. Risk Selection Issues under Medicare Reform Proposals. Menlo Park, CA: Kaiser Family Foundation.
13. Clement, D. G., S. M. Retchin, and R. S. Brown. 1994. Satisfaction with Access and Quality of Care in Medicare Risk Contract HMOs. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
14. Clement, D. G., S. M. Retchin, R. S. Brown, and M. H. Stegall. 1994. Access and Outcomes of Elderly Patients Enrolled in Managed Care. New England Journal of Medicine 271:1487-1492.
15. Coffey, E., I. Moscovice, M. Finch, J. B. Christianson, and N. Lurie. 1994. Capitated Medicaid and the Process of Care of Elderly Hypertensives and Diabetics: Results from a Randomized Trial. American Journal of Medicine 98:531-536.
16. Congressional Budget Office (CBO). 1995. Cost Estimate for HR 2485 (Medicare Preservation Act of 1995). Washington, DC.
17. Dowd, B., J. Christianson, R. Feldman, C. Wisner, and J. Klein. 1992. Issues Regarding Health Plan Performance under Medicare and Recommendations for Reform. Milbank Quarterly 70:423-453.
18. Eckholm, E. 1996. HMOs Are Changing the Face of Medicare. New York Times, 10 January, p. A1.
19. Eggars, P. W., and R. Prihoda. 1982. Pre-enrollment Reimbursement Patterns of Medicare Beneficiaries Enrolled in "At-Risk" HMOs. Health Care Financing Review 4:55-13.
20. Ellwood, P. M., and A. C. Enthoven. 1995. Responsible Choices: The Jackson Hole Group Plan for Health Reform. Health Affairs 14(2):24-39.
21. Enthoven, A. C. 1980. Health Plan: The Only Practical Solution to the Soaring Costs of Medical Care. Reading, MA: Addison-Wesley.
22. Evans, A. 1995. The Federal Health Benefits Program, Managed Competition, and Considerations for Medicare. Washington, DC: National Academy on Aging.
23. Feder, J. M. 1977. Medicare: The Politics of Federal Health Insurance. Lexington, MA: Heath.
24. Findlay, S., and W. J. Meyeroff. 1996. Health Costs: Why Employers Won Another Round. Business and Health 14(3) (March):49-51.
25. Freudenheim, M. 1994. To Economists, Managed Care Is No Cure-All. New York Times, 6 September, p. A1.
26. Friedman, B., and R. L. Kane. 1993. HMO Directors' Perceptions of Geriatric Practice in Medicare HMOs. Journal of the American Geriatric Society 41:1144-1149.
27. Gillick, M. R. 1987. The Impact of Health Maintenance Organizations on Geriatric Care. Annals of Internal Medicine 106(1):139-143.
28. Grimaldi, P. L. 1995. Medicaid Switching to Managed Care. Nursing Management 26(7):12-17.
29. Hanchak. N. A., S. R. Harmon-Weiss. P. D. McDermott, A. Hirsch, and N. Schlack-man. 1996. Medicare Managed Care and the Need for Quality Measurement. Managed Care Quarterly 4(1):1-12.
30. Harrington, C., M. Lynch, and R. J. Newcomer. 1993. Medical Services in Social Health Maintenance Organizations. Gerontologist 33:790-800.
31. Hellinger, F. J. 1995. Selection Bias in HMOs and PPOs: A Review of the Evidence. Inquiry 32:135-142.
32. Iglehart. J. K. 1985. Medicare Turns to HMOs. New England Journal of Medicine 312(2):132-136.
33. 1987. Second Thoughts about HMOs for Medicare Patients. New England Journal of Medicine 316:1487-1492.
34. Jencks, S. F., and G. R. Wilensky. 1992. The Health Care Quality Improvement Initiative. Journal of the American Medical Association 268:900-903.
35. Kaiser Family Foundation. 1995. Medicare Chart Book. Menlo Park, CA: Kaiser Family Foundation.
36. Kane. R. L. 1995. Health Care Reform and the Care of Older Adults. Journal of the American Geriatric Society 43:702-706.
37. King. G. 1994. Health Care Reform and the Medicare Program. Health Affairs 13(5):39-43.
38. Langwell. K., and J. Hadley. 1989. Evaluation of the Medicare Competition Demonstrations. Health Care Financing Review 11(2):65-80.
39. 1990. Insights from the Medicare HMO Demonstrations. Health Affairs 9(1):74-84.
40. Langwell, K., L. Nelson, and S. Nelson. 1988. Direct Physician Capitation under the Medicare Program: Evidence and Feasibility. In Lessons from the First Twenty Years of Medicare, ed. M. V. Pauly and W. L. Kissick. Philadelphia: University of Pennsylvania Press.
41. Lichenstein, R. L., J. W. Thomas, J. Adams-Watson, J. Lepkowski, and B. Simone. 1991. Selection Bias in TEFRA At-Risk HMOs. Medical Care 29:318-331.
42. Lichenstein, R. L., J. W. Thomas. B. Watkins, C. Puto, J. Lepkowski, J. Adams-Watson, B. Simone, and D. Vest. 1992. HMO Marketing and Selection Bias. Medical Care 30:329-345.
43. Luft, H. S. 1981. Health Maintenance Organizations: Dimensions of Performance. New York: Wiley.
44. 1982. Health Organizations and the Rationing of Medical Care. Milbank Quarterly 60:268-306.
45. ed. 1994. HMOs and the Elderly. Ann Arbor, MI: Health Administration Press.
46. Luft, H. S., and R. H. Miller. 1988. Patient Selection in a Competitive Medical System. Health Affairs 7(3):97-119.
47. Manning, W. G., A. Leibowitz, G. Goldberg, W. Rogers, and J. P. Newhouse. 1984. A Controlled Trial of the Effect of Prepaid Group Practice on Use of Service. New England Journal of Medicine 310:1505-1510.
48. Martin, C. J. 1997. Markets, Medicare, and Making Do: Business Strategies after National Health Care Reform. Journal of Health Politics, Policy and Law 22:557-593.
49. McCombs, J. S. J. D. Kasper, and G. F. Riley. 1990. Do HMOs Reduce Health Care Costs: A Multivariate Analysis of Medicare HMO Demonstration Projects. Health Services Research 24:593-613.
50. McMillan, A. 1993. Trends in Medicare Health Maintenance Organization Enrollment. Health Care Financing Review 15:135-146.
51. Mechanic, D. 1994. Managed Care: Rhetoric and Realities. Inquiry 31(2):124-128.
52. Miller, R. H., and H. S. Luft. 1994a. Managed Care Plans: Characteristics, Growth, and Premium Performance. Annual Review of Public Health 15:437-459.
53. 1994b. Managed Care Plan Performance since 1980. Journal of the American Medical Association 271:1512-1518.
54. Moon, M. 1993. Medicare: Now and in the Future. Washington, DC: Urban Institute.
55. Moon, M., and K. Davis. 1995. Preserving and Strengthening Medicare. Health Affairs 14(4):31-46.
56. Newcomer, R., C. Harrington, and S. Preston. 1994. Satisfaction in the Social/Health Maintenance Organization. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
57. Olmos, D. R. 1995. Kaiser Plans Cost Cutting $800 Million. Los Angeles Times, 23 September, p. D1.
58. Pear, Robert. 1996. U.S. Shelves Plan to Limit Rewards to HMO Doctors. New York Times, 8 July, p. A1.
59. Physician Payment Review Commission (PPRC). 1995a. Estimated Payment Rates for MedicarePlus Plans. Washington, DC: U.S. Government Printing Office.
60. 1995b. Annual Report to Congress. Washington, DC: U.S. Government Printing Office.
61. Porell, F. W., and C. P. Tompkins. 1993. Medicare Risk Contracting: Identifying Factors Associated with Market Exit. Inquiry 30:157-169.
62. Preston, J. A., and S. M. Retchin. 1991. The Management of Geriatric Hypertension in Health Maintenance Organizations. Journal of the American Geriatric Society 39:683-690.
63. Prospective Payment Commission (ProPAC). 1995. Medicare and the American Health Care System. Washington, DC: ProPAC.
64. Retchin, S. M., and B. Brown. 1990a. The Quality of Ambulatory Care in Health Maintenance Organizations. American Journal of Public Health 80:411-415.
65. 1990b. Management of Colorectal Cancer in Medicare Health Maintenance Organizations. Journal of General Internal Medicine 5:110-114.
66. 1991. Elderly Patients with Congestive Heart Failure under Prepaid Care. American Journal of Medicine 90:236-242.
67. Retchin, S. M., and D. G. Clement. 1992. How the Elderly Fare in HMDs: Outcomes from the Medicare Competition Demonstrations. Health Services Research 27:651-669.
68. Retchin, S. M., D. G. Clement, and R. S. Brown. 1994. Care of Patients Hospitalized with Strokes under the Medicare Risk Program. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
69. Retchin, S. M., and J. A. Preston. 1991. Effects of Cost Containment on the Care of Elderly Diabetics. Archives of Internal Medicine 151:2244-2248.
70. Rich. S. 1996. Even Tougher Debate on Medicare Expected As Baby Boomers Age. Washington Post, 6 February, p. A13.
71. Riley, G. F., A. L. Potosky, and J. D. Lubitz, M. L. Brown. 1994. Stage of Cancer at Diagnosis for Medicare HMO and Fee-for-Service Enrollees. American Journal of Public Health 84:1598-1604.
72. Robinson. J. C. 1991. HMO Market Penetration and Hospital Cost Inflation in California. Journal of the American Medical Association 266:2719-2723.
73. Robinson. J. C., H. S. Luft, L. B. Gardner, and E. M. Morrison. 1991. A Method for Risk-Adjusting Employer Contributions to Competing Health Insurance Plans. Inquiry 28:107-116.
74. Rossiter, L. F., H. C. Chiu, and J. H. Chen. 1994. Strengths and Weaknesses of the AAPCC. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
75. Rossiter, L. F., K. Langwell, T. T. H. Wan, and M. Rivnyak. 1989. Patient Satisfaction among Elderly Enrollees and Disenrollees in Medicare Health Maintenance Organizations. Journal of the American Medical Association 262:57-63.
76. Rossiter, L. F., T. Wan, K. Langwell, J. Hadley, A. Tucker, M. Rivnyak, K. Sullivan, and J. Norcross. 1988. An Analysis of Patient Satisfaction for Enrollees and Disenrollees in Medicare Risk-Based Plans. Richmond, VA: Report for the Health Care Financing Administration.
77. Schlenker, R. E., P. W. Shaughnessy, and D. F. Hittle. 1995. Patient-Level Cost of Home Health Care under Capitated and Fee-for-Service Payment. Inquiry 32:252-270.
78. Schlesinger, M. 1986. On the Limits of Expanding Health Care Reform: Chronic Care in Prepaid Settings. Milbank Quarterly 64(2):189-215.
79. 1995. Ethical Issues in Policy Advocacy. Health Affairs 14(3):23-29.
80. Schlesinger, M., and P. B. Drumheller. 1988. Medicare and Innovative Insurance Plans. In Renewing the Promise: Medicare and Its Reform, ed. D. Blumenthal, M. Schlesinger, and P. B. Drumheller. New York: Oxford University Press.
81. Schlesinger, M., and D. Mechanic. 1993. Challenges for Managed Competition from Chronic Illness. Health Affairs (12 Suppl.):123-137.
82. Schlesinger, M., and T. Wetle. 1988. Medicare's Coverage of Health Services. In Renewing the Promise, ed. D. Blumenthal, M. Schlesinger, P. Brown, and P. B. Drumheller. New York: Oxford University Press.
83. Shaughnessy, P. W., R. E. Schlenker, and D. F. Hittle. 1994. Home Health Outcomes under Capitated and Fee-for-Service Payment. Health Care Financing Review 16(1):187-221.
84. Shortell, S. M., and K. E. Hull. 1995. The New Organization of Health Care: The Evolution of Managed Care and Organized Delivery Systems. Baxter II Health Policy Review:1-49.
85. Sofaer, S., and M. L. Hurwicz. 1993. When Medical Group and HMO Part Company: Disenrollment Decisions in Medicare HMOs. Medical Care 31:808-821.
86. Spitz, B., and J. Abramson. 1987. Competition, Capitation, and Case Management: Barriers to Strategic Reform. Milbank Quarterly 65:348-370.
87. Sullivan, L. W. 1990. Disenrollment Experience in the Medicare HMO and CMP Risk Program: 1985-1988. Report to Congress. Washington, DC: Department of Health and Human Services,
88. Thomas, B. 1995. Medicare at a Crossroads. Journal of the American Medical Association 274:276-278.
89. U.S. General Accounting Office (GAO). 1991. Medicare: PRO Review Does Not Ensure Quality of Care Provided by Risk HMOs. Washington, DC: U.S. Government Printing Office.
90. 1995. Medicare: Increased HMO Oversight Could Improve Quality and Access to Care. Washington, DC: U.S. Government Printing Office.
91. 1996a. Medicare HMOs: Rapid Enrollment Growth Concentrated in Selected States. Washington, DC: U.S. Government Printing Office.
92. 1996b. Medicare: Federal Efforts to Enhance Patient Quality of Care. Washington, DC: U.S. Government Printing Office.
93. Ware, J. E., M. S. Bayliss, W. H. Rogers, M. Kosinski, and A. R. Tarlov. 1996. Differences in Four-Year Health Outcomes for Elderly and Poor, Chronically 111 Patients Treated in HMO and Fee-for-Service Systems. Journal of the American Medical Association 276:1039-1047.
94. Ware, J. E., R. H. Brook, W. H. Rogers, E. B. Keeler, A. R. Davies, C. D. Sherbourne, G. A. Goldberg, P. Camp, and J. P. Newhouse. 1986. Comparison of Health Out-comes at a Health Maintenance Organization with Those of Fee-for-Service Care. Lancet, 3 May, pp. 1017-1022.
95. Wiener, J. M., L. H. Illston, and R. J. Hanley. 1994. Sharing the Burden. Washington, DC: Brookings Institution.
96. Welch, W. P. 1994. HMO Market Share and Its Effect on Local Medicare Costs. In HMOs and the Elderly, ed. H. S. Luft. Ann Arbor, MI: Health Administration Press.
97. Wilensky, G. 1995a. The Score on Medicare Reform - Minus the Hype and Hyperbole. New England Journal of Medicine 333:1774-1777.
98. 1995b. Incremental Health System Reform: Where Medicare Fits In. Health Affairs 14(1):173-181.
99. Zarbozo, C., and J. D. LeMasurier. 1995. Medicare and Managed Care. In Essentials of Managed Health Care, ed. P. Kongstvedt. Gaithersburg, MD: Aspen.
100. Zwanziger, J., and G. Melnick. 1993. Effects of Competition on the Hospital Industry: Evidence from California. In Competitive Approaches to Health Care Reform, ed. R. J. Arnould, R. F. Rich, and W. D. White. Washington, DC: Urban Institute.