Articlegreen1993

Do health maintenance organizations work for Medicare?

Randall Brown · Dolores G. Clement · Jerrold W. Hill · Sheldon M. Retchin · Jeannette W. Bergeron

131 citations0/0 files storedPubMed Central

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Healthcare Policy and Management Healthcare Systems and Reforms Healthcare cost, quality, practices

Abstract

Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.

Citations in this library

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References

1984A Controlled Trial of the Effect of a Prepaid Group Practice on Use of Services 1989Adjusting Medicare capitation payments using prior hospitalization data.

Cited by

2012New Risk-Adjustment System Was Associated With Reduced Favorable Selection In Medicare Advantage 2013The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization 2014How Successful Is Medicare Advantage?2006Predictability and predictiveness in health care spending 2003The Welfare Impact of Medicare HMOs 1999How well does a single question about health predict the financial health of Medicare managed care plans?2003Understanding Biased Selection in Medicare HMOs 2002Do Medicare HMOs still reduce health services use after controlling for selection bias?

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