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Fee-for-service Health Care Expenditures
Joan BuchananShan CretinRand Corporation
其他書名
Evidence of Selection Effects Among Subscribers who Choose HMOs
出版Rand, 1986
主題Business & Economics / Insurance / HealthMedical / Health Care DeliveryMedical / Practice Management & Reimbursement
ISBN08330070339780833007032
URLhttp://books.google.com.hk/books?id=iYo5zQEACAAJ&hl=&source=gbs_api
註釋Although competition among health plans has been encouraged as a means to control health care expenditures, some fee-for-service (FFS) insurers attribute part of their increased average expenditures to favorable selection of low users into newly offered health maintenance organization (HMO) plans. To test this hypothesis, the health care expenditure patterns of approximately 30,000 employees in a large, multi-site aerospace firm were examined. FFS system expenditure patterns for people who joined HMOs were compared with those of people who remained in the FFS system. Information on socioeconomic status, plan choice, employee dependents, and filed claims were reviewed. The unit of observation was a family year of claimed expenditures. Expenditure data for families that switched between FFS and HMO plans between 1978 and 1982 were classified into four groups: (1) one year preHMO; (2) other years preHMO; (3) one year postHMO; and (4) other years postHMO. For families remaining in FFS plans, all years of data were "stayer" years. Family year expenditures were compared across these five groups. The results revealed that families selecting HMOs had lower mean expenditures than did families who remained in the FFS system. Families who left HMOs had higher mean expenditures than did those who entered HMOs. Some, but not all, of these differences were explained by family characteristics. (NB)