Managed Care for Preventive Services: A Review of Policy Options

Schauffler, Helen Halpin; Rodriguez, Tracy

doi:10.1177/107755879305000203

Cited by 19 publications

(10 citation statements)

References 74 publications

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“…This focus is warranted because preventive medicine is the cornerstone of good medical care and as such it has important effects on disease progression, morbidity, and mortality. Despite the importance of good preventive care, research suggests that such care has been underutilized in the United States [13]. In a report identifying key problems with quality of care in the United States, The President's Advisory Commission on Consumer Protection and Quality in the Health Care Sector [14] specifically cited problems with underutilization of preventive care, including flu shots, mammography and screenings for colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Are HMOs bad for health maintenance?

Rizzo

2005

Health Econ.

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This study examines the impact of Health Maintenance Organization (HMO) coverage on the provision of preventive medicine. We investigate whether any association reflects selection effects on the part of patients and/or physicians or a causal impact of managed care itself. Causal effects may occur on the supply side or the demand side. Using a large national database of Medicare and non-Medicare patients, we investigate these issues for eight common preventive medical procedures. We find that preventive care is substantially higher with HMO coverage than with traditional fee-for-service reimbursement. Our findings also suggest that the impact of HMOs on preventive medicine is a causal one, and does not merely reflect selection effects. Both supply-side (e.g. provider) and demand-side (e.g. patient) factors appear to play a role in the higher incidence of preventive care among HMO enrollees. Patient demand effects are stronger for simple treatments such as physicals, while supply-side effects seem to dominate for relatively complex preventive care procedures such as mammograms.

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Section: Introductionmentioning

confidence: 99%

Are HMOs bad for health maintenance?

Rizzo

2005

Health Econ.

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“…But more recent research (Schauffler and Rodriguez, 1993;Donelan et al, 1996) calls this finding into question: the wide range of treatments and competition between HMOs, especially over prices, makes patients more fickle and less likely to remain loyal to their insurer. This significantly diminishes the attraction of spending on prevention and screening programmes.…”

Section: Vulnerable Patients and Hmos: A Circle Difficult To Squarementioning

confidence: 99%

“…On the other hand, preventive care and screening programmes seem to be more intensive under the HMO system, whether for the population in general (Callahan and Bertakis, 1993;Bernstein et al, 1991), patients with chronic illnesses (Godfrey and Christiansen, 1995), Medicaid patients (Carey et al, 1990), children (Ballards et al, 1997, older people including Medicare patients (Eppig and Poisal, 1993) or diabetics (Retchin and Preston, 1991). But more recent research (Schauffler and Rodriguez, 1993;Donelan et al, 1996) calls this finding into question: the wide range of treatments and competition between HMOs, especially over prices, makes patients more fickle and less likely to remain loyal to their insurer. This significantly diminishes the attraction of spending on prevention and screening programmes.…”

Section: Vulnerable Patients and Hmos: A Circle Difficult To Squarementioning

confidence: 99%

Managed care and traditional insurance: Comparing quality of care

Simonet

2003

Int Social Security Review

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The article compares quality of care under the traditional “fee–for–service” system with that given by “managed care” providers in the United States. Outcomes have been mixed, with most studies reporting on one hand a decline in the propensity of patients of health maintenance organizations (HMOs) to seek treatment and, on the other, lower patient satisfaction. The quality of care has not deteriorated, however, except in the case of that given to vulnerable patients.

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“…Frank and Welch (1985), Feldman et al (1990), and Wholey, Feldman, and Christianson (1995) examine competitive impacts. Schauffler and Rodriguez (1993) review the issues and empirical findings with respect to preventive care.…”

Section: Impacts Of Hmosmentioning

confidence: 99%

Hmos and Health Externalities: A Local Public Good Perspective

Goodman

Stano

2000

Public Finance Review

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This article introduces a Health Maintenance Organization (HMO) model that characterizes HMO decisions on enrollment, utilization levels, and quality. Facing global budgets dependent on revenue raising capacity, HMOs must determine standards of care and the corresponding premiums to cover costs. Revenues are allocated among HMO providers by gatekeepers who are often subject to strict utilization controls. Our model identifies various uncompensated health and pecuniary externalities that may result from patient disenrollments, thereby affecting treatment costs. As a result of these externalities HMOs may provide less than socially efficient levels of care; and they may also enroll less than socially efficient numbers of members. The model also predicts that HMOs may promote socially cost inefficient treatment options for conditions where multiple options are available.

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Managed Care for Preventive Services: A Review of Policy Options

Cited by 19 publications

References 74 publications

Are HMOs bad for health maintenance?

Are HMOs bad for health maintenance?

Managed care and traditional insurance: Comparing quality of care

Hmos and Health Externalities: A Local Public Good Perspective

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