Employer-Sponsored Health Insurance, 1989

Gabel, John; DiCarlo, Steven; Sullivan, Cynthia B.; Rice, Thomas

doi:10.1377/hlthaff.9.3.161

Cited by 30 publications

(3 citation statements)

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“…It also should be noted that until the advent of managed care and other recent changes in health care financing, that most indemnity type insurance plans did not cover many routine health care maintenance services such as immunizations. 33 Therefore since a substantive amount of pediatric ambulatory care was accounted for by out-of-pocket expenditures, pediatricians in the premanaged care era may have had more incentives to locate where individuals could afford such expenses. Again the transition to managed care is changing the mode and patterns of physician reimbursement dramatically.…”

Section: Discussionmentioning

confidence: 99%

Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC

Chang

Halfon

1997

Pediatrics

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The distribution of pediatricians does not parallel the distribution of the child population in the US, nor has this distribution changed substantially in spite of a 38.6% increase in the PCPR. Pediatricians tend to concentrate in states with high per capita income and in states with a larger number of residency training positions. The failure of market forces to improve the geographic distribution may require manpower policy changes designed to improve distribution in underrepresented states. The uncertain impact of market changes due to increased use of managed care could affect distributional requirements of pediatricians in the future.

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Section: Discussionmentioning

confidence: 99%

Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC

Chang

Halfon

1997

Pediatrics

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“…The median out-of-pocket limit was $1,000, which would be reached by charges of $6,000. Only the 20 percent of persons with a limit greater than $2,000 would be likely to pay 20 percent coinsurance on the full $3,000 of difference (Gabel et al 1990). Grazier and McGuire (1987) estimate that mothers paid only 1 percent of the costs of an extra day, on average, at the large urban hospital they studied.…”

Section: Mothers' Incentivesmentioning

confidence: 99%

Economic Incentives in the Choice between Vaginal Delivery and Cesarean Section

Keeler¹,

Brodie²

1993

The Milbank Quarterly

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The dramatic rise in cesarean-section (C-section) rates, and their high costs and wide variation, has raised interest in understanding the factors affecting decisions to use this procedure. The economic incentives of physicians, hospitals, payers, and mothers are examined. In the economic framework, physicians must balance their short-term interests against their reputation, which is derived from efficiently providing what mothers want. Providers who encounter higher opportunity costs while attending to mothers in prolonged labor can reduce these costs by operating or by restructuring their practices. The mainly indirect evidence on financial incentives indicates that insured mothers have low marginal financial costs when they undergo C-section. Mothers with private, fee-for-service insurance have higher C-section rates than mothers who are covered by staff-model HMOs, who are uninsured, or who are publicly insured. In conclusion, research and payment reforms to reduce distortions to good practice are proposed.

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“…For example, the Houston Area Health Care Coalition provided the Employee Benefits Research Institute (EBRI) with two years' worth of inpatient claims in which 55 percent were subject to utilization review, EBRI found that the inpatient charges for those covered by utilization review were 15 percent lower than for those without (Vibhert 1990: 40, 37-46), 4, In addition, some companies believe that HMOs engage in shadow pricing: their rate increases follow those of traditional fee-for-service plans (Odynocki 1988), 5. A Health Affairs study found that premiums for conventional fee for-service plans increased by 20 percent from 1988-89, and PPO premiums increased by 18 percent (Gqabel et al, 1990), 6, Some companies contracted with centers of excellence for high-priced interventions such as organ transplants. These special arrangements often offered both somewhat lower prices for interventions and much better medical outcomes (Christensen 1991), tional indemnity plans.…”

Section: Firm-level Iviaricet Interventionsmentioning

confidence: 99%

Markets, Medicare, and Making Do: Business Strategies After National Health Care Reform

Martin

1997

Journal of Health Politics, Policy and Law

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This essay examines the role of business health care purchasers in keeping market solutions at the center of the health system. One might assume that employers would have a clear ideological preference for market solutions, but big business managers are ambivalent about market interventions at both the firm and public policy levels. Although currently enthusiastic about market-oriented managed care, large employers have been periodically disappointed by firm-level market experitnents during the past two decades. They viewed with skepticism the Republican proposal to apply private-sector market cures to the public Medicare and Medicaid, fearing that the proposals would accelerate cost-shifting to private business payers. Big business objections have been muted, however, by the organizational weakness so vividly illustrated during the national health reform debate.

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Employer-Sponsored Health Insurance, 1989

Cited by 30 publications

References 1 publication

Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC

Geographic Distribution of Pediatricians in the United States: An Analysis of the Fifty States and Washington, DC

Economic Incentives in the Choice between Vaginal Delivery and Cesarean Section

Markets, Medicare, and Making Do: Business Strategies After National Health Care Reform

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