Managed Care Plan Performance Since 1980: A Literature Analysis

JAMA: The Journal of the American Medical Association

Volumn 271, Issue 19, 1994, Pages 1512-1519

  Miller, Robert H ^a   Luft, Harold S ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH CARE COST; HEALTH CARE QUALITY; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH SERVICE; HOSPITAL MANAGEMENT; PHYSICIAN; PRIORITY JOURNAL; REVIEW;

EID: 84942950665     PISSN: 00987484     EISSN: 15383598     Source Type: Journal    
DOI: 10.1001/jama.1994.03510430066037     Document Type: Article

References (83)

1. Luft HS. Health Maintenance Organizations: Dimensions of Performance. New York, NY: John Wiley & Sons Inc; 1981.
2. Manning WG, Leibowitz A, Goldberg GA, Rogers WH, Newhouse JP. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984;310:1505-1510.
3. Carey T, Weis K, Homer C. Prepaid versus traditional Medicaid plans: Effects on preventive health care. J Clin Epidemiol. 1990;43:1213-1220.
4. Carey TS, Weis K, Homer C. Prepaid versus traditional Medicaid plans: Lack of effect on pregnancy outcomes and prenatal care. Health Serv Res. 1991;26:165-181.
5. Krieger JW, Connell FA, LoGerfo JP. Medicaid prenatal care: A comparison of use and outcomes in fee-for-service and managed care. Am J Public Health. 1992;82:185-190.
6. Hurley RE, Freund DA, Paul JE. Managed Care in Medicaid: Lessons for Policy and Program Design. Ann Arbor, Mich: Health Administration Press; 1993.
7. Martin DP, Diehr P, Price KF, Richardson WC. Effect of a gatekeeper plan on health services use and charges: A randomized trial. Am J Public Health. 1989;79:1628-1632.
8. Clement DG, Retchin SM, Stegall MH, Brown RS. Evaluation of Access and Satisfaction With Care in the TEFRA Program. Princeton, NJ: Mathematica Policy Research Inc; 1992.
9. Hill J, Brown R, Chu D, Bergeron J. The Impact of the Medicare Risk Program on the Use of Services and Costs to Medicare. Princeton, NJ: Mathematica Policy Research Inc; 1992.
10. Brown RS, Bergeron JW, Clement DG, Hill JW, Retchin SM. The Medicare Risk Program for HMOs: Final Summary Report on Findings From the Evaluation. Princeton, NJ: Mathematica Policy Research Inc; 1993.
11. Brown RS, Hill J. Does Model Type Play a Role in the Extent of HMO Effectiveness in Controlling the Utilization of Services? Princeton, NJ: Mathematica Policy Research Inc; 1993.
12. Retchin SM, Brown R, Cohen R, et al. The Quality of Care in TEFRA HMOs/CMPs: Final Version. Princeton, NJ: Mathematica Policy Research Inc; 1992.
13. Newcomer R, Harrington C, Preston S. Satisfaction in the Social/Health Maintenance Organization: A Comparison of Members, Disenrollees, and Those in Fee for Service. San Francisco, Calif: Institute for Health and Aging, University of California—San Francisco; 1993.
14. Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource utilization among medical specialties and systems of care: Results from the Medical Outcomes Study. JAMA. 1992;267:1624-1630.
15. Johnson AN, Dowd B, Morris NE, Lurie N. Differences in inpatient resource use by type of health plan. Inquiry. 1989;26:388-398.
16. Stafford RS. Cesarean section use and source of payment: An analysis of California hospital discharge abstracts. Am J Public Health. 1990;80:313-315.
17. Stafford RS. The impact of nonclinical factors on repeat cesarean section. JAMA. 1991;265:59-63.
18. Retchin SM, Brown B. The quality of ambulatory care in Medicare health maintenance organizations. Am J Public Health. 1990;80:411-415.
19. Hlatky MA, Lee KL, Botvinick EH, Brundage BH. Diagnostic test use in different practice settings: A controlled comparison. Arch Intern Med. 1983;143:1886-1889.
20. Young GJ, Cohen BB. Inequities in hospital care: The Massachusetts experience. Inquiry. 1991; 28:255-262.
21. Cummings SR, Stein MJ, Hansen B, Richard RJ, Gerbert B, Coates TJ. Smoking counseling and preventive medicine: A survey of internists in private practices and a health maintenance organization. Arch Intern Med. 1989;149:345-349.
22. Bredfeldt RC, Brewer ML, Junker JA. Influences upon reported health promotion by family physicians. Fam Pract Res J. 1990;9:85-94.
23. Tarlov AR, Ware JE Jr, Greenfield S, Nelson ED, Perrin E, Zubkoff M. The Medical Outcomes Study: An application of methods for monitoring the results of medical care. JAMA. 1989;262:925-930.
24. Kravitz RL, Greenfield S, Rogers W, et al. Differences in the mix of patients among medical specialties and systems of care: Results from the Medical Outcomes Study. JAMA. 1992;267:1617-1623.
25. McCusker J, Stoddard AM, Sorensen AA. Do HMOs reduce hospitalization of terminal cancer patients? Inquiry. 1988;25:263-270.
26. Wolfe F, Kleinheksel SM, Spitz PW, et al. A multicenter study of hospitalization in rheumatoid arthritis: Effect of health care system, severity, and regional difference. J Rheumatol. 1986;13:277-284.
27. Yelin EH, Shern MA, Epstein WV. Health outcomes for a chronic disease in prepaid group practice and fee-for-service settings. Med Care. 1986; 24:236-246.
28. Welch WP. Health care utilization in HMOs: Results from two national samples. J Health Econ. 1985;4:293-308.
29. Braveman PA, Egerter S, Bennett T, Showstack J. Differences in hospital resource allocation among sick newborns according to insurance coverage. JAMA. 1991;266:3300-3308.
30. Arnould RJ, Debrock LW, Pollard JW. Do HMOs produce specific services more efficiently? Inquiry. 1984;21:243-253.
31. Stern RS, Juhn PI, Gertler PJ, Epstein AM. A comparison of length of stay and costs for health maintenance organizations and fee-for-service patients. Arch Intern Med. 1989;149:1185-1188.
32. Bradbury RC, Golec JH, Stearns FE. Comparing hospital length of stay in independent practice association HMOs and traditional insurance programs. Inquiry. 1991;28:87-93.
33. Rapoport J, Gehlbach S, Lemeshow S, Teres D. Resource utilization among intensive care patients: Managed care vs traditional insurance. Arch Intern Med. 1992;152:2207-2212.
34. Fitzgerald JF, Moore PS, Dittus RS. The care of elderly patients with hip fracture: Changes since implementation of the prospective payment systern. N Engl J Med. 1988;319:1392-1397.
35. Dowd B, Feldman R, Cassou S, Finch M. Health plan choice and the utilization of health care services. Rev Econ Stat. 1991;73:85-93.
36. Lubeck DP, Brown BW, Holman HR. Chronic disease and health system performance: Care of osteoarthritis across three health services. Med Care. 1985;23:266-277.
37. Norquist GS, Wells KB. How do HMOs reduce outpatient mental health care costs? Am J Psychiatry. 1991;148:96-101.
38. Udvarhelyi IS, Jennison K, Phillips RS, Epstein AM. Comparison of the quality of ambulatory care for fee-for-service and prepaid patients. Ann Intern Med. 1991;327:424-429.
39. Szilagyi PG, Roghmann KJ, Foye HR, et al. The effect of independent practice association plans on use of pediatric ambulatory medical care in one group practice. JAMA. 1990;263:2198-2203.
40. Wells KB, Hosek SD, Marquis MS. The effects of preferred provider options in fee-for-service plans on use of outpatient mental health services by three employee groups. Med Care. 1992;30:412-427.
41. Garnick DW, Luft HS, Gardner LB, et al. Services and charges by PPO physicians for PPO and indemnity patients: An episode of care comparison. Med Care. 1990;28:894-906.
42. Wouters AV. The cost of acute outpatient primary care in a preferred provider organization. Med Care. 1990;28:573-585.
43. Retchin SM, Brown B. Management ofcolorectal cancer in Medicare health maintenance organizations. J Gen Intern Med. 1990;5:110-114.
44. McCloskey L, Petitti DB, Hobel CJ. Variations in the use of cesarean delivery for dystocia: Lessons about the source of care. Med Care. 1992;30:126-135.
45. Lessler DS, Avins AL. Cost, uncertainty, and doctors' decisions: The case of thrombolytic therapy. Arch Intern Med. 1992;152:1665-1671.
46. McCombs JS, Kasper JD, Riley GF. Do HMOs reduce health care costs? a multivariate analysis of two Medicare HMO demonstration projects. Health Serv Res. 1990;25:593-613.
47. Zwanziger J, Auerbach RR. Evaluating PPO performance using prior expenditure data. Med Care. 1991;29:142-151.
48. Palsbo SJ, Gold MR. HMO Industry Profile, Volume 3: Financial Performance, 1988. Washington, DC: Group Health Association of America; 1990.
49. McLaughlin CC. The effect of HMOs on overall hospital expenses: Is anything left after correcting for simultaneity and selectivity? Health Serv Res. 1988;23:421-442.
50. McLaughlin CG. HMO growth and hospital expenses and use: A simultaneous-equation approach. Health Serv Res. 1987;22:183-205.
51. Hadley J, Swartz K. The impacts on hospital costs between 1980 and 1984 of hospital rate regulation, competition, and changes in health insurance coverage. Inquiry. 1989;26:35-47.
52. Friedman B, Shortell S. The financial performance of selected investor-owned and not-for-profit system hospitals before and after Medicare prospective payment. Health Serv Res. 1988;23:237-267.
53. Robinson JC. HMO market penetration and hospital cost inflation in California. JAMA. 1991; 266:2719-2723.
54. Melnick GA, Zwanziger J. Hospital behavior under competition and cost-containment policies. JAMA. 1988;260:2669-2675.
55. Hay/Huggins Co. 1992 Hay/Huggins Benefits Report: Executive Summary. Philadelphia, Pa: Hay/ Huggins Co Inc; 1993.
56. KPMG Peat Marwick. Health Benefits in 1992. Newark, NJ: KPMG Peat Marwick; 1992.
57. Sullivan CB, Miller M, Feldman R, Dowd B. Employer-sponsored health insurance in 1991. Health Aff. 1992;11:172-185.
58. Foster Higgins. Foster Higgins Health Care Benefits Survey, Report 1: Medical Plans. Princeton, NJ: A. Foster Higgins; 1992.
59. Feldman R, Dowd B, Gifford G. The effect of HMOs on premiums in employment-based health plans. Health Serv Res. 1993;27:779-812.
60. Gabel J, Formisano R, Lohr B, DiCarlo S. Tracing the cycle of health insurance. Health Aff. 1991; 10:48-61.
61. Gabel JR. Perspective: A look at insurance data. Health Aff. 1992;11:186-190.
62. Short PF. Trends in employee health insurance benefits. Health Aff. 1988;7:186-196.
63. Bernstein AB, Thompson GB, Harlan LC. Differences in rates of cancer screening by usual source of medical care: Data from the 1987 National Health Interview Survey. Med Care. 1991;29:196-209.
64. Ornstein SM, Garr DR, Jenkins RG, et al. Compliance with five health promotion recommendations in a university-based family practice. J Fam Pract. 1989;29:163-168.
65. Retchin SM, Brown B. Elderly patients with congestive heart failure under prepaid care. Am J Med. 1991;90:236-242.
66. Retchin SM, Preston J. Effects of cost containment on the care of elderly diabetics. Arch Intern Med. 1991;151:2244-2248.
67. Retchin SM, Clement DG, Rossiter LF, et al. How the elderly fare in HMOs: Outcomes from the Medicare Competition Demonstration. Health Serv Res. 1992;27:651-670.
68. Preston, JA, Retchin SM. The management of geriatric hypertension in health maintenance organizations. J Am Geriatr Soc. 1991;39:683-690.
69. Vernon SW, Hughes JI, Heckel VM, Jackson GL. Quality of care for colorectal cancer in a fee-for-service and health maintenance organization practice. Cancer. 1992;69:2418-2425.
70. Carlisle DM, Siu AL, Keeler EB, et al. HMO vs fee-for-service care of older persons with acute myocardial infarction. Am J Public Health. 1992;82: 1626-1630.
71. Miller NA. An evaluation of substance misuse treatment providers used by an employee assistance program. Int J Addict. 1992;27:533-559.
72. MurrayJP, Greenfield S, Kaplan SH, Yano EM. Ambulatory testing for capitation and fee for service patients in the same practice setting: Relationship to outcomes. Med Care. 1992;30:252-261.
73. Wells KB, Hays RD, Burnam MA, Rogers W, Greenfield S, Ware JE Jr. Detection of depressive disorder for patients receiving prepaid or fee-for-service care: Results from the Medical Outcomes Study. JAMA. 1989;262:3298-3302.
74. Rogers WH, Wells KB, Meredith LS, Sturm R. Burnam MA. Outcomes for adult outpatients with depression under prepaid or fee-for-service financing. Arch Gen Psychiatry. 1993;50:517-525.
75. Rubin HR, Gandek B, Rogers WH, Kosinski M, McHorney CA, Ware JE Jr. Patients' ratings of outpatient visits in different practice settings: Results from the Medical Outcomes Study. JAMA. 1993;270:835-840.
76. Rossiter LF, Langwell K, Wan TT, Rivnyak M. Patient satisfaction among elderly enrollees and disenrollees in Medicare health maintenance organizations: Results from the National Medicare Competition Evaluation. JAMA. 1989;262:57-63.
77. Luft HS. How do health maintenance organizations achieve their 'savings'? rhetoric and evidence. N Engl J Med. 1978;298:1336-1343.
78. Luft HS. Trends in medical care costs: Do HMOs lower the rate of growth? Med Care. 1980;18:1-16.
79. Newhouse JP, Schwartz WB, Williams AP, Witsberger C. Are fee-for-service costs increasing faster than HMO costs? Med Care. 1985;23:960-966.
80. Ware JE, Brook RH, Rogers WH, et al. Comparison of health outcomes at a health maintenance organization with those of a fee-for-service care. Lancet. 1986;1:1017-1022.
81. Sloss EM, Keeler EB, Brook RH, et al. Effect of a health maintenance organization on physiologic health: Results from a randomized trial. Ann Intern Med. 1987;106:130-136.
82. Lichtenstein R, Thomas JW, Watkins B, et al. HMO marketing and selection bias: Are TEFRA HMOs skimming? Med Care. 1992;30:329-346.
83. Riley G, Lubitz J, Rabey E. Enrollee health status under Medicare risk contracts: An analysis of mortality rates. Health Serv Res. 1991;26:137-163.