Ten Ways HMOs Have Changed during the 1990s

Health Affairs

Volumn 16, Issue 3, 1997, Pages 134-145

  Gabel, Jon ^a  

^a KPMG LLP   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMIC ASPECT; HEALTH CARE QUALITY; HEALTH ECONOMICS; HEALTH MAINTENANCE ORGANIZATION; HUMAN; ORGANIZATION; ORGANIZATION AND MANAGEMENT; UNITED STATES;

ECONOMIC COMPETITION; ECONOMICS, MEDICAL; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; ORGANIZATIONAL INNOVATION; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 0345908345     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.3.134     Document Type: Article

References (32)

1. C.B. Sullivan and T. Rice, "The Health Insurance Picture in 1990," Health Affairs (Summer 1991): 104-115.
2. KPMG Peat Marwick LLP, Health Benefits in 1995 (San Francisco: KPMG Peat Marwick, 1995), 26. Managed care is commonly defined as health plans that contract selectively with providers on a discounted basis and provide utilization management and quality assurance. This definition includes health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.
3. Ibid., 14-17.
4. Group Health Association of America, Patterns in HMO Enrollment (Washington: GHAA, June 1994); and American Association of Health Plans, Managed Health Care Overview (Washington: AAHP, 1996).
5. Group Health Association of America, Patterns in HMO Enrollment (Washington: GHAA, June 1994); and American Association of Health Plans, Managed Health Care Overview (Washington: AAHP, 1996).
6. Group Health Association of America, HMO Industry Profile: 1994 Edition (Washington: GHAA, 1995).
7. R.H. Miller et al., "San Diego, Calif.: Site Visit Report," in The Community Snapshots Project: Capturing Health System Change, ed. P.B. Ginsburg and N.J. Fasciano (Washington: Center for Studying Health System Change, 1996).
8. Organizations that regularly survey HMOs term these arrangements as "mixed models" but continue to classify the core business as the HMO model type. For example, if a staff model contracts with community physicians, but the majority of HMO members continue to receive their care at the HMO-owned clinics and hospitals, then the HMO would be termed a "staff-mixed model."
9. R. Hurley et al., Arrangements between Managed Care Plans and Physicians II: A Follow-Up on the Analysis of 1994 Survey Data and Site Visit Information (Washington: Physician Payment Review Commission, June 1996).
10. KPMG Peat Marwick LLP, Health Benefits in 1996 (Montvale, N.J.: KPMG Peat Marwick, 1996).
11. S. Findlay, "Will Big HMOs Stamp Out Competition?" Business and Health (October 1995): 174-181.
12. L. Zuckerman, "PacifiCare Will Buy FHP, Its Health Care Rival," The New York Times, 6 August 1996, D1; M. Freudenheim, "Health Plans in New Jersey Face Rivalries," The New York Times, 30 May 1996, D1; and M. Freudenheim, "A Merger of Health Insurers," The New York Times, 2 April 1996, D1.
13. L. Zuckerman, "PacifiCare Will Buy FHP, Its Health Care Rival," The New York Times, 6 August 1996, D1; M. Freudenheim, "Health Plans in New Jersey Face Rivalries," The New York Times, 30 May 1996, D1; and M. Freudenheim, "A Merger of Health Insurers," The New York Times, 2 April 1996, D1.
14. L. Zuckerman, "PacifiCare Will Buy FHP, Its Health Care Rival," The New York Times, 6 August 1996, D1; M. Freudenheim, "Health Plans in New Jersey Face Rivalries," The New York Times, 30 May 1996, D1; and M. Freudenheim, "A Merger of Health Insurers," The New York Times, 2 April 1996, D1.
15. Findlay, "Will Big HMOs Stamp Out Competition?"
16. E. Eckholm, "While Congress Remains Silent, Health Care Transforms Itself," The New York Times, 18 December 1994, A1.
17. R. Feldman, D. Wholey, and J. Christianson, "A Descriptive Economic Analysis of HMO Mergers and Failures: 1985-1992," Medical Care Research and Review (June 1995): 279-304.
18. A. Hillman, W. Welch, and M. Pauly, "Contractual Arrangements between HMOs and Primary Care Physicians. Three Tiered HMOs and Risk Pools," Medical Care (February 1992): 136-143.
19. M. Gold et al., Arrangements between Managed Care Plans and Physicians: Results from a 1994 Survey of Managed Care Plans (Washington: Mathematica Policy Research, 1994).
20. Ibid., 75. The figures were derived by the author of this paper.
21. KPMG Peat Marwick, Health Benefits in 1995, 29-45.
22. D. Cherkin, L. Grothaus, and E. Wagner, "The Effect of Office Visit Copayments on Utilization in a Health Maintenance Organization," Medical Care (July 1989): 669-678.
23. H. Luft, Health Maintenance Organizations: Dimensions of Performance (New York: Wiley, 1981).
24. J. Firshein, "Measuring Progress towards Practice Guidelines, Clinical Guidelines, and Doctors," Business and Health (June 1995): 38.
25. Gold et al., Arrangements between Managed Care Plans and Physicians.
26. A. Bernstein et al., 1994 HMO Performance Report (Washington: Group Health Association of America, December 1994), 10-11.
27. Specifically, in 1995 and 1996 premiums increased by 2.1 percent and 0.5 percent, while overall inflation rose by 3.2 percent and 2.9 percent, and workers earnings grew by 2.7 percent and 2.9 percent. KPMG Peat Marwick, Health Benefits in 1996.
28. U.S. News and World Report, "America's Top HMOs" (2 September 1996): 58-69.
29. J. Quinn, "Is Your HMO OK - or Not?" Newsweek (10 February 1997): 52.
30. Unpublished data from KPMG Peat Marwick's 1996 Employer Benefit Survey.
31. R.H. Miller and H.S. Luft, "Managed Care Plan Performance since 1980: A Literature Analysis," Journal of the American Medical Association (18 May 1994): 1512-1519.
32. J. Ware et al., "Differences in 4-Year Health Outcomes for Elderly and Poor Chronically Ill Patients Treated in HMO and Fee-for-Service Systems," Journal of the American Medical Association (2 October 1996): 1039-1047.