M B Rosenthal

..Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness...

..I consider alternative explanations for this new benefit design trend and conclude that the desire to distribute tangible benefits to the largest number of constituents is most plausible...

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..In addition, evidence was found that in a setting where providers serve multiple payers, the share of their total revenue derived from risk-sharing contracts is an important determinant of the magnitude of the supply response...

..Because of the critical role payment incentives play in guiding practice patterns, it is hard to imagine substantial reform of the delivery system without coordinated changes in payment...

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..Guidelines issued in 1997 by the Food and Drug Administration (FDA) regarding advertising to consumers through electronic media are considered by some to be responsible for unleashing a flood of direct-to-consumer advertising...

..We assessed whether beneficiaries in MMC plans were more likely than those in traditional FFS insurance to receive colorectal cancer (CRC) screening and whether type of insurance was associated with use of specific screening strategies...

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..Physician organizations appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures, and consolidating into larger entities...

..If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections...

..While the current environment has not generated much demand for risk adjustment, we reflect on its future potential...

..Moreover, other important ethical issues arise with regard to the risks imposed on the population by the introduction of policies that are based on a faith in markets rather than empirical evidence...

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..Further research on the nature of provider and consumer rationing decisions is needed to inform the design of supply-side and demand-side incentives that will lead to an efficient allocation of services...

..Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care...

..To explore the implications of current approaches used by health plans and purchasers to identify preferred hospitals for tiered networks using cost and quality information...

..Moreover, the Food and Drug Administration (FDA) has been criticized for its weak enforcement of laws regulating such advertising...

..To examine the impact of incentive formularies on prescription drug spending shifts in formulary compliance, use of generic medications, and mail-order fulfillment in the year after introduction of a new pharmacy benefit strategy...

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..Thirteen percent of medical groups and 19 percent of IPAs provided bonuses or withholds based on utilization or cost performance, which averaged 10 percent of base compensation...

..The association between the organizational structure of physician groups and health care quality has never been evaluated empirically...

..As the design of Medicare with pay for performance moves forward, it will be important to leverage the early experience of pay for performance in the commercial market...

..To examine the current state of quality monitoring and management activities of US health plans...

..Using cost-effectiveness methods to profile hospital "value'' permits the comparison of the benefit of a service relative to the cost using existing societal weights...

..To the extent that the value of the health benefits is not offset by the value of the pleasure foregone, the economic impacts of the MSA will include a share of these health benefits...

..Even in non-health settings, however, where the institutional features are more favorable to a positive impact, the literature contains mixed results on the effectiveness of analogous pay-for-performance schemes...

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