Structural problems of managed care in California and some options for ameliorating them

California Management Review

Volumn , Issue 1, 2000, Pages 50-65

  Singer, Sara J ^a   Enthoven, Alain C ^a  

^a NONE

Author keywords

[No Author keywords available]

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EID: 0034559612     PISSN: 00081256     EISSN: None     Source Type: Journal    
DOI: 10.2307/41166065     Document Type: Article

References (45)

1. Cecil C. Cutting, "Historical Development and Operating Concepts," in A.R. Somers, The Kaiser Permanente Medical Care Program (New York, NY: Commonwealth Fund, 1971), p. 17-22.
2. The InterStudy, Competitive Edge (St. Paul, MN: InterStudy Publications, 1985).
3. The InterStudy, Competitive Edge (St. Paul, MN: InterStudy Publications, 2000).
4. The InterStudy, Managed Care: A Decade in Review 1980-1990, (Bloomington, MN: InterStudy Publications, 1991); The InterStudy, Competitive Edge 10.1, (St. Paul, MN: InterStudy Publications, 2000).
5. The InterStudy, Managed Care: A Decade in Review 1980-1990, (Bloomington, MN: InterStudy Publications, 1991); The InterStudy, Competitive Edge 10.1, (St. Paul, MN: InterStudy Publications, 2000).
6. Alain Enthoven and Sara Singer, "The Backlash and the Task Force in California," Health Affairs (July/August 1998), p. 97; Alain Enthoven and Sara Singer, "Managed Competition and California's Health Care Economy," Health Affairs (Spring 1996), p. 41.
7. Alain Enthoven and Sara Singer, "The Backlash and the Task Force in California," Health Affairs (July/August 1998), p. 97; Alain Enthoven and Sara Singer, "Managed Competition and California's Health Care Economy," Health Affairs (Spring 1996), p. 41.
8. "Findings and Recommendations: Government Regulation and Oversight of Managed Health Care," Managed Health Care Improvement Task Force Final Report, January 5, 1998, p. 51.
9. According to the last available data, in 1996, California physicians had an average of 15 managed care contracts. Nationwide, physicians had an average of 11.2 managed care contracts. American Medical Association, "Number of Managed Care Contracts per Practice, 1996," Physician Marketplace Statistics (1996).
10. Sara Singer et al., "Decreasing Variation in Medical Necessity Decision Making: Final Report to the California HealthCare Foundation, August 1999," (〈http://chppcor.stanford.edu〉〉 under "Research," June 2000).
11. It is also unclear whether consumers have the ability to assess the relative value of medical groups due to a lack of comparative quality information and questionable interest and ability in applying it.
12. See, for example, Eric Young, "Leverage at Root of Hospital, Plan Split," Sacramento Bee, May 31, 1998, p. E1.
13. Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
14. California Managed Health Care Improvement Task Force, "Public Perceptions and Experiences with Managed Care," Improving Managed Health Care in California, Findings and Recommendations, Vol. Two, January 5, 1998, p. 16. Traditional PPOs are insurance companies that contract with large numbers of physicians that are not otherwise related to one another, creates financial incentives for insured patients to obtain services from contracted physicians, and pay physicians negotiated fees for services rendered. More recently, many PPOs have adopted strategies to manage utilization and cost similar to those used by many HMOs.
15. "Real Problems and Real Solutions: Making the Voices of Health Care Consumers Count," Health Rights Hotline, 1999.
16. California Managed Health Care Improvement Task Force, "Public Hearing Notes," Improving Managed Health Care in California, Background Papers, Vol. Three, January 5, 1998, p. 213-361. Eric L. Chehab et al., "The Impact of Practice Setting on Physician Perceptions of the Quality of Practice and Patient Care in the Managed Care Era," Archives of Internal Medicine, forthcoming.
17. California Managed Health Care Improvement Task Force, "Public Hearing Notes," Improving Managed Health Care in California, Background Papers, Vol. Three, January 5, 1998, p. 213-361. Eric L. Chehab et al., "The Impact of Practice Setting on Physician Perceptions of the Quality of Practice and Patient Care in the Managed Care Era," Archives of Internal Medicine, forthcoming.
18. Alain Enthoven and Sara Singer, "The Backlash and the Task Force in California," Health Affairs (July/August 1998), p. 103.
19. California Managed Health Care Improvement Task Force, "Health Industry Profile," Improving Managed Health Care in California, Background Papers, Vol. Three, January 5, 1998, p. 124.
20. California Managed Health Care Improvement Task Force, "Expanding Consumer Choice of Health Plans," Improving Managed Health Care in California, Background Papers, Vol. Three, January 5, 1998, p. 34-44
21. The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits, 1999 Annual Survey (1999).
22. The PBGH web site address is 〈www.healthscope.org〉, October 2000.
23. See for example, Aetna US Healthcare "Coverage Policy Bulletins," 〈http://www.aetnaushc.com/cpb/index.html〉, October 2000.
24. Interview with CALINX/NIPAC staff, November 10, 1999; Interview with CALINX/PBGH staff, November 17, 1999.
25. Interview with NIPAC staff, September 17, 1998.
26. Peter Kilborn, "California Agency Ponders Bypassing Health Groups," The New York Times, March 22, 1998, Section 1, p. 20; Interview with Office of Public Affairs, Health Benefits staff, May 8, 2000.
27. Andrew LePage, "Huge Pension Funds Discuss Health-Care Alliance," The Sacramento Bee, December 20, 1999, 〈www.sacbee.com/ib/news/ib_news01_ 19991220.htm〉.
28. Prudential Securities Equity Research, "Managed Care Industry Update," (March 2, 1998).
29. "California Medical Groups in Difficulty," Integrated Healthcare Report (July 1999), p. 12-13; Kathy Robertson, "Hospitals Refuse Capitation Pacts," Sacramento Business Journal, May 15, 2000; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
30. "California Medical Groups in Difficulty," Integrated Healthcare Report (July 1999), p. 12-13; Kathy Robertson, "Hospitals Refuse Capitation Pacts," Sacramento Business Journal, May 15, 2000; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
31. "California Medical Groups in Difficulty," Integrated Healthcare Report (July 1999), p. 12-13; Kathy Robertson, "Hospitals Refuse Capitation Pacts," Sacramento Business Journal, May 15, 2000; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
32. Managed Health Care Improvement Task Force, "Government Regulation and Oversight of Managed Health Care: Findings and Recommendations," January 5, 1998, p. 49; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
33. Managed Health Care Improvement Task Force, "Government Regulation and Oversight of Managed Health Care: Findings and Recommendations," January 5, 1998, p. 49; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
34. California Senate Bill 260 (Speier) of 1999 establishes a Financial Solvency Standards Board within the newly created Department of Managed Care and directs the Board to develop financial solvency requirements and regulations for provider contracts and operations.
35. See, for example, "PacifiCare's $150M Deal with Sutter," Integrated Healthcare Report, September 1997, p. 9.
36. "A Risky Proposition? Risk-Bearing and Solvency in California's Medical Groups," California Health Policy Roundtable (Menlo Park, CA: The Henry J. Kaiser Family Foundation, February 2000), p. 2; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
37. "A Risky Proposition? Risk-Bearing and Solvency in California's Medical Groups," California Health Policy Roundtable (Menlo Park, CA: The Henry J. Kaiser Family Foundation, February 2000), p. 2; Integrated Healthcare Association, "Preserving and Strengthening the Delegated Model in California," August 1999.
38. Sharon Bernstein, "PacifiCare Will Pay More for Medical Costs," Los Angeles Times, August 4, 2000, p. 1; Bernard Wolfson, "Aetna Looks at Reimbursement Policy," The Orange County Register, August 11, 2000, 〈www.ocregister.com/archives〉.
39. Sharon Bernstein, "PacifiCare Will Pay More for Medical Costs," Los Angeles Times, August 4, 2000, p. 1; Bernard Wolfson, "Aetna Looks at Reimbursement Policy," The Orange County Register, August 11, 2000, 〈www.ocregister.com/archives〉.
40. California Senate Bill 260 (Speier) of 1999.
41. Knox-Keene Health Care Service Plan Act of 1975 Including Amendments Enacted in 1998, Section 1346, and accompanying regulation 1300.46 Prohibition of Bonuses or Gratuities in Solicitations, states "No person subject to the provisions of the Act shall offer or otherwise distribute any bonus or gratuity to potential subscribers for the purpose of inducing enrollment or to existing subscribers for the purpose of inducing the continuation of enrollment." Interpretation provided by Department of Corporations Legal Counsel, February 25, 1999.
42. Davan Maharaj, "HMO Releases Scorecard on Doctor Groups," Los Angeles Times, September 1, 1997, p. 1.
43. "Empire's Strategy for Health Care," Editorial, The New York Times, October 8, 1997, p. A22.
44. "After the Oxford Debacle," Editorial, The New York Times, March 2, 1998, p. A18.
45. Glover, "Blue Cross Expands Health Plan Options," Sacramento Bee, June 29, 1998, p. 1B9.