New directions for public health care purchasers? Responses to looming challenges

Health Affairs

Volumn 25, Issue 6, 2006, Pages 1518-1528

  McKethan, Aaron ^a,b   Gitterman, Daniel ^b   Feezor, Allen ^c,d,e   Enthoven, Alain ^f  

^a LEWIN GROUP   (United States)

^b UNIVERSITY OF NORTH CAROLINA   (United States)

^c University Health Systems of Eastern Carolina   (United States)

^d California Public Employees Retirement System (CalPERS)   (United States)

^e California Public Employees Retirement System ^*

^f STANFORD UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCOUNTING; ADULT; AGED; ECONOMICS; EPIDEMIOLOGY; GOVERNMENT; HEALTH CARE COST; HEALTH INSURANCE; HUMAN; INTERVIEW; MANAGEMENT; MEDICARE; MIDDLE AGED; RETIREMENT; REVIEW; SOCIOECONOMICS; STANDARD; UNITED STATES;

ACCOUNTING; ADULT; AGED; EMPLOYER HEALTH COSTS; GOVERNMENT AGENCIES; HEALTH BENEFIT PLANS, EMPLOYEE; HEALTH CARE SURVEYS; HUMANS; INTERVIEWS; MEDICARE; MIDDLE AGED; POLICY MAKING; RETIREMENT; SOCIOECONOMIC FACTORS; STATE GOVERNMENT; UNITED STATES;

EID: 33845327119     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.6.1518     Document Type: Review

References (23)

1. S.H. Long and M.S. Marquis, "Comparing Employee Health Benefits in the Public and Private Sectors, 1997," Health Affairs 18, no. 6 (1999): 183-193;
2. C. Watts et al., "The Role of Public Employers in a Changing Health Care Market," Health Affairs 22, no. 1 (2003): 173-180;
3. and M.L. Maciejewski, B.E. Dowd, and R. Feldman, "How Do States Purchase Health Insurance for Their Own Employees?" Managed Care Quarterly 5, no. 3 (1997): 11-19.
4. J. Maxwell, P. Temin, and T. Petigara, "Private Health Purchasing Practices in the Public Sector: A Comparison of State Employers and the Fortune 500," Health Affairs 23, no. 2 (2004): 182-190;
5. and R.E. Hurley et al., "Public Employees' Health Benefits Survive Major Threats, So Far," Health Affairs 25 (2006): w195-w203 (published online 18 April 2006; 10.1377/hlthaff.25.w195).
6. To select the twelve large PEHPs for our study, we compared results from recent Henry J. Kaiser Family Foundation (KFF)/Health Research and Educational Trust (HRET) and Segal Corporation surveys reporting PEHP enrollment data. Given different enrollment accounting strategies and some missing data in these surveys, some excluded PEHPs could have larger enrollments than some that were included. See KFF-HRET, KFF/HRET Survey: 2002 State Employee Health Plans, July 2003, http://www.kff.org/insurance/6100-index.cfm (accessed 22 August 2006);
7. and Segal Company, 2003 Segal State Health Benefits Survey, http:// www.segalco.com/publications/surveysandstudies/2003statesurvey_medicalbenefits. pdf (accessed 11 September 2006).
8. U.S. Bureau of the Census, Statistical Abstract of the United States, 2005 (Washington: U.S. Government Printing Office, 2005).
9. D.W. Moran, "Whence and Whither Health Insurance? A Revisionist History," Health Affairs 24, no. 6 (2005): 1415-1425.
10. Maxwell et al., "Private Health Purchasing."
11. Interview with Jarvio Grevious, deputy executive officer, CalPERS, 23 March 2006.
12. Four other hospitals were restored to the network upon a determination that their inclusion was necessary to ensure members broad access to health care providers throughout the state.
13. Interview with Dolores Mitchell, executive director, Massachusetts Group Insurance Commission (MGIC), 26 April 2006.
14. G. Mays, G. Claxton, and B. Strunk, "Tiered-Provider Networks: Patients Face Cost-Choice Trade-Offs," Issue Brief no. 71 (Washington: Center for Studying Health System Change, November 2003).
15. For example, see the following op-ed from the president of the Massachusetts Medical Society: K. Peelle, "Measuring Quality in Healthcare," Boston Globe, 5 September 2006.
16. This might not apply to all CalPERS beneficiaries in local governments. Many local government agencies, influenced heavily by public employee unions, pay the whole premium, which has the effect of undermining the elasticity of demand.
17. S. Wisniewski and L. Wisniewski, "State Government Retiree Health Benefits: Current Status and Potential Impact of New Accounting Standards," July 2004, http://www.aarp.org/research/work/benefits/aresearch-import-883- 2004-08.html (accessed 22 August 2006).
18. Government Accounting Standards Board, "Summary of Statement no. 45, Accounting and Financial Reporting by Employers for Postemployment Benefits Other than Pensions" (Issued June 2004), http:// 72.3.167.244/st/summary/ gstsm45.html (accessed 11 August 2006).
19. E.G. Hill and J. Dickerson, "Retiree Health Care: A Growing Cost for Government," 17 February 2006, http://www.lao.ca.gov/2006/ret_hlthcare/ retiree_healthcare_021706.pdf (accessed 22 August 2006).
20. Gabriel, Roeder, Smith, and Company, "The Report of the Actuarial Valuation of the State of South Carolina Retiree Health Care Plan" (Unpublished, 24 February 2006).
21. Eligible employers will receive an RDS payment for each Medicare-eligible retiree equal to 28 percent of allowable drug costs attributable to gross prescription drug costs between a cost threshold ($250 in 2006) up to a cost limit ($5,000 in 2006).
22. D. Holtz-Eakin, "Estimating the Cost of the Medicare Modernization Act," Testimony before the House Committee on Ways and Means, 24 March 2004, http://www.cbo.gov/showdoc.cfm?index=5252&sequence=0 (accessed 12 April 2006).
23. Exceptions include CalPERS members who are enrolled in Kaiser Permanente, which is a Medicare Advantage (MA) Plan.