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Data from the Community Tracking Study give a glimpse of who among the privately insured are likely to switch plans, and why.b y P e t e r J. Cu n n i n g h a m a n d L i n d a K o h n C h a n g i n g h e a l t h p l a n s may be beneficial to the extent that it results from consumers' decisions and preferences about what type of health plan best suits their health care needs. On the other hand, consumers today are not only choosing a plan to finance the use of services, but within that decision are also choosing a delivery system or network of providers. Therefore, changing health plans may lead to a change in physicians, which may prove harmful to continuity of care, access, and quality. 1 The extent to which changes in health plans are beneficial or potentially harmful depends on the answers to several key questions: How frequently are changes made, especially by vulnerable populations who are already at risk for problems with medical care access and quality? To what extent is changing plans voluntary (for example, consumers exercising choice) or involuntary (for example, forced changes by employers)? How often does changing health plans lead to a change in the place that persons usually receive medical care?Previous studies have been limited to the experience of a single company, which makes it difficult to generalize to the privately insured population as a whole.2 Using data from the 1996-1997 Community Tracking Study (CTS) household survey, this study is among the first to examine consumers' switching among private insurance plans nationwide. Data And Methodsn Data. The CTS is a major initiative of the Robert Wood Johnson Foundation (RWJF) to track changes in the health care system over time and to gain a better understanding of how health system changes are affecting people.3 The CTS household survey was designed to produce representative estimates for the U.S. population as well as for sixty randomly selected communities. The sample was based on random-digit dialing, as well as on a small field sample to represent households without telephones. A family respondent was selected to report on health insurance coverage (among other factors) for other persons in the family included in the survey (all adults and one randomly selected child). 4 The overall response rate for the household survey was 65 percent for families.The sample includes 32,732 families and 60,446 individuals. The sample for this analysis includes 37,545 nonelderly persons who were privately insured throughout the survey year (1996)(1997). 5n Determining plan switching. We include both employer-sponsored private insurance and private insurance plans that are purchased directly by the enrollee. For persons covered by private insurance on the day of the interview, a change of health plans was considered to have occurred if they first enrolled in their current plan during the prior twelve months and if their previous plan was also private insurance (asked in the survey). Persons continuously covered by the same private insurance plan through...

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During the 1980s California hospitals responded to selective contracting, growth in managed care, and the Medicare prospective payment system (PPS) by controlling their level of spending. This DataWatch examines whether these hospitals achieved these savings by changing the number and/or the mix of hospital employees. We examined employment trends because wages represent the largest component of hospital budgets and because the number and mix of personnel can be changed in the short run. Analysis of the California Health Facilities Cost Report data shows that employment increased steadily during 1982-1994. There is no evidence that hospitals responded to growing competition by altering the rate of growth in hospital personnel and only weak evidence that they altered the mix of personnel by hiring a greater proportion of nonclinical staff. We conclude that increased competition had only a minor effect on hospital employment decisions.

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