competitive medical plans
Summary: Alternative health care delivery mechanisms, such as PREFERRED PROVIDER ORGANIZATIONS or other health insurance services or prepaid plans (other than HEALTH MAINTENANCE ORGANIZATIONS), that meet Medicare qualifications for a risk-sharing contract. (From Facts on File Dictionary of Health Care Management, 1988)
- [Promoting competition and improving quality. Accepting the intergenerational contract by stabilizing health care reform]J Wasem
Lehrstuhl für Allgemeine BWL, und Gesundheitsmanagement, Ernst Moritz Arndt Universitat Greifswald, Friedrich Loeffler Str 70 17489 Greifswald
Z Gerontol Geriatr 35:292-6. 2002..The reform proposal by an expert group, invited by the Friedrich-Ebert-Foundation to develop a concept of health care reform, takes these considerations into account...
- Competition in health insurance--is there such a thing in Iowa?Lucinda Stephenson
Iowa Med 92:20-2. 2002
- Cost sharing revisitedTom Miller
Health Aff (Millwood) 25:883; author reply 883-4. 2006
- Will choice-based reform work for Medicare? Evidence from the Federal Employees Health Benefits ProgramCurtis S Florence
Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
Health Serv Res 41:1741-61. 2006..To examine the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer...
- Insuring Californians: a proposal that mattersRick Curtis
Health Policy Solutions, Washington, DC, USA
Health Aff (Millwood) 26:w92-5. 2007..In this commentary we suggest some modifications to achieve a more viable plan...
- What does social enterprise mean for community nursing?Rosemary Cook
Queen s Nursing Institute, London
Br J Community Nurs 11:472-4. 2006..Rosemary Cook takes a look at the thinking behind social enterprise, its potential role in the NHS and what is could mean for community nursing...
- Competition on outcomes and physician leadership are not enough to reform health careJennifer Dixon
King's Fund, London, England
JAMA 298:1445-7. 2007
- Testing: can financial incentives improve performance and quality?Ed Rabinowitz
AHIP Cover 48:36-8, 41-2, 44. 2007
- Systematic review: the evidence that publishing patient care performance data improves quality of careConstance H Fung
RAND, Santa Monica, California 90407 2138, USA
Ann Intern Med 148:111-23. 2008..Previous reviews have shown inconsistent effects of publicly reported performance data on quality of care, but many new studies have become available in the 7 years since the last systematic review...
- [GKV-WSG--what is the status today?]Jörg Andreas Rüggeberg
Chirurg . 2007
- Medicare risk contracting: determinants of market entryF W Porell
Heller School, Brandeis University, Waltham, MA 02254
Health Care Financ Rev 12:75-85. 1990..Act (TEFRA) of 1982 made it more attractive for health maintenance organizations (HMOs) and other competitive medical plans to enter into risk contracts with Medicare...
- The health plan choices of retirees under managed competitionT C Buchmueller
Graduate School of Management, University of California, Irvine 92697, USA
Health Serv Res 35:949-76. 2000..To investigate the effect of price on the health insurance decisions of Medicare-eligible retirees in a managed competition setting...
- HMOs healthier, less abused, but fail to increase market share. Interview by Patrick MullenRichard L Hamer
Manag Care 11:42-3, 47. 2002
- Strengths and limitations of competitive versus non-competitive models of integrated capitated fundholdingLeonie Segal
Health Economics Unit, Monash University, West Heidelberg, Vic, Australia
J Health Serv Res Policy 7:S56-64. 2002..Future research on this issue is clearly required...
- Managed competition: issues for AustraliaD Scotton
National Centre for Health Program Evaluation, Monash University, Melbourne
Aust Health Rev 18:82-104. 1995....
- Consumer assessments of care for children and adults in health plans: how do they compare?Chunliu Zhan
Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA
Med Care 40:145-54. 2002..This study examined how adult and child assessments differed in ranking health plans and explored whether the differences justified the additional cost and respondent burden in administering both surveys...
- Alternatives to Federal regulatory realignment of health careC J Kalkhof
Group Health Inc, Buffalo, NY
Healthc Financ Manage 48:34, 36, 38 passim. 1994....
- Consumer-driven health care marketingR L Upton
Browning, Dolby and Sanders Advertising Milwaukee, WI, USA
Manag Care Q 5:25-9. 1997..They understand--as does their employer--that no longer are all health care plans alike or at parity with each other. The consumer is also demanding greater access to freedom of provider choice, quality of health care coverage...
- Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global feesD W Emery
Public Employees Health Program of Utah, Salt Lake City, USA
Manag Care Q 5:64-72. 1997..Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness...
- The role of the physician and the present and emerging health care channelK W Westbrook
University of Memphis, USA
J Hosp Mark 12:1-22. 1997..Propositions are offered that explain recent vertical integration. Moreover, a conceptual model of the future health care channel is offered for capitated pricing...
- Confirmatory factor analysis of the Consumer Assessment of Health Plans Study (CAHPS) 1.0 Core SurveyG N Marshall
RAND, Health Sciences, 1700 Main Street, P O Box 2138, Santa Monica, California 90407 2138, USA
Psychol Assess 13:216-29. 2001..Magnitude of factor loadings and correlations among factors was essentially equivalent within a common health service sector. A higher order factor analysis revealed that rating and reports of care showed marked convergence...
- A tale of four cities: Medicare reform and competitive pricingB Dowd
Division of Health Services Research and Policy, University of Minnesota, USA
Health Aff (Millwood) 19:9-29. 2000..In the absence of political support, a demonstration of competitive pricing may be infeasible, and Congress could be forced to take the risky step of implementing broad Medicare reforms with very little information about their effects...
- The structure of risk adjustment for private plans in MedicareJoseph P Newhouse
Harvard University, 180 Longwood Ave, Boston, MA 02115, USA
Am J Manag Care 17:e231-40. 2011....
- Interest grows in consumer-driven health plansKate Traynor
Am J Health Syst Pharm 60:130. 2003
- Effects of health savings account-eligible plans on utilization and expendituresMary E Charlton
Rural Health Resource Center, Iowa City, IA 52246, USA
Am J Manag Care 17:79-86. 2011....
- Unhealthy competition: consequences of health plan choice in California MedicaidChristopher Millett
Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA
Am J Public Health 100:2235-40. 2010..We compared the quality of care received by managed care Medicaid beneficiaries in counties with a choice of health plans and counties with no choice...
- Taxing cadillac health plans may produce Chevy resultsJon Gabel
National Opinion Research Center, Bethesda, Maryland, USA
Health Aff (Millwood) 29:174-81. 2010..1 percent of this variation. Industry type and medical costs in the region also play a role. Most variation in premiums, however, remains largely unexplained...
- Early adverse drug event signal detection within population-based health networks using sequential methods: key methodologic considerationsJeffrey S Brown
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA
Pharmacoepidemiol Drug Saf 18:226-34. 2009..Our objective was to expand our previous signal detection work by investigating the effect on signal detection of alternative study specifications...
- [Legal framework of private health insurance with risks and benefits]F Beske
Versicherungsmedizin 60:57-8. 2008
- [Does the cartel law affect the established sector?]H J Schade
Aktuelle Urol 39:111-2. 2008
- Early detection of adverse drug events within population-based health networks: application of sequential testing methodsJeffrey S Brown
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA, USA
Pharmacoepidemiol Drug Saf 16:1275-84. 2007....
- Let's explore a truly free market, consumer driven health care systemMariannette Miller-Meeks
Iowa Med 97:8. 2007
- Quality of care in for-profit and not-for-profit health plans enrolling Medicare beneficiariesEric C Schneider
Department of Health Policy and Management, Harvard School of Public Health, USA
Am J Med 118:1392-400. 2005..For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care...
- [Competition in the health care system]Olli-Pekka Lehtonen
Duodecim 121:937-8. 2005
- Paying for performance: implementing a statewide project in CaliforniaCheryl L Damberg
RAND, Santa Monica, California, USA
Qual Manag Health Care 14:66-79. 2005
- Should benefit to individuals outweigh good for groups?MargaretAnn Cross
Manag Care 12:33. 2003
- Capitation and risk adjustment in health care financing: an international progress reportN Rice
University of York
Milbank Q 79:81-113, IV. 2001..In practice, however, the setting of capitation payments has been heavily constrained to date by poor data availability and unsatisfactory analytic methodology...
- From evolution to revolution: restructuring the New Zealand health systemT Ashton
School of Medicine, University of Auckland, New Zealand
Health Care Anal 1:57-62. 1993..The costs of the reform process have, however, already been high, both in financial terms and in terms of their impact on the morale of health workers...
- Are competing psychotherapists manageable?M J Bennett
Medco Behavioral Care Systems, Burlington, MA
Manag Care Q 2:36-42. 1994..Shared accountability is proposed as an alternative to the problematic ethic of competition...
- Questions and answers about managed competitionC M Clancy
Center for National Health Program Studies, Cambridge Hospital, MA 02139
Int J Health Serv 23:213-8. 1993..Managed Competition would empower vertically integrated corporate health care insurer/providers and disempower patients and the clinical work force...
- Managed competition that worksP Caper
Codman Research Group, Inc, Lebanon, NH 03766
JAMA 269:2524-6. 1993..Although this proposal is written as a national plan, trust funds could be implemented at the state level, if problems associated with portability of benefits among states could be solved...
- President Clinton's managed competition proposalT P Weil
Bedford Health Associates Inc, Management Consultants for Health and Hospital Services, Asheville, NC 28801
J Natl Med Assoc 85:257-63. 1993....
- Getting to go in managed careG R Wolford
Alliant Health System, Louisville, KY
Health Care Manage Rev 18:7-19. 1993....
- The marketplace in health care reform. The demographic limitations of managed competitionR Kronick
Department of Community and Family Medicine, University of California San Diego, La Jolla 92093
N Engl J Med 328:148-52. 1993..We examined the demographic features of health markets in the United States to see what proportion of the population lives in areas that might successfully support managed competition...
- A specialized mental health plan for persons with severe mental illness under managed competitionR Scheffler
Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, Western Consortium for Public Health, Berkeley, CA
Hosp Community Psychiatry 44:937-42. 1993..Alternatively, HIPCs could require the general health plan to operate or contract for MHMOs. In each case, the HIPC would provide quality-of-care oversight and assign a team to act as a gatekeeper for referrals to the MHMO...
- Health care reform: clarifying the conceptsA M Miller
Ball State University, School of Nursing, Muncie, IN 47306
J Community Health Nurs 10:199-211. 1993..Reform is inevitable. The challenge for nurses is to understand reform issues and then influence policymakers to initiate reforms that make essential medical and preventive services universally available...
- How will changes in health insurance tax policy and employer health plan contributions affect access to health care and health care costs?M S Marquis
RAND, Washington, DC 20037 1270
JAMA 271:939-44. 1994....
- Managing the health care system under a global expenditure limit: a workshop summaryD L Rogal
Alpha Center, Washington, DC 20036
Inquiry 30:318-27. 1993....
- [Quality management between science and competition]H K Selbmann
Institut für Medizinische Informationsverarbeitung, Universitat Tubingen, Deutschland
Gynakol Geburtshilfliche Rundsch 34:139-44. 1994..but the only way to a widely applied total quality management is quality-assuring activities and quality becoming factors of competition themselves...
- Healthcare reform wars. Somebody could get hurtR E Moffit
Heritage Foundation, Washington, DC
Postgrad Med 96:47-51, 55-6. 1994....
- Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993J La Puma
Department of Medicine, Lutheran General Hospital, Park Ridge, Ill
Arch Fam Med 3:665-71. 1994..Both doctors and patients want to have strong, personal, values-oriented relationships. Whether such relationships are possible under the Health Security Act remains to be seen...
- Strategies for implementing global budgetsJ Holahan
Urban Institute, Washington, DC 20037
Milbank Q 72:399-429. 1994..The fourth model is singled out for its ability to control costs. An independent policy toward capital expenditures could increase the likelihood of success under any of the strategies...
- Managed competition: a critical analysisA L Jackson
Michael Reese Hospital, Chicago, IL 60616 3390
J Health Care Poor Underserved 5:252-5. 1994..A single-payer alternative presents a more viable way of reducing administrative costs and providing health insurance for all...
- Managed competition for the poor: more promise than value?T P Weil
Bedford Health Associates, Inc, Asheville, NC 28801
J Health Care Poor Underserved 5:158-68; discussion 169-72. 1994....
- Saying goodbye to Canada's single-payer systemC Carruthers
Ottawa Civic Hospital
CMAJ 152:731-3. 1995..The result, says Carruthers, is that government influence is bound to diminish as the private sector tries to fill voids created by governments that are trying to live within their fiscal means...
- Estimating health expenditure growth under managed competition. Science, simulations, and scenariosR H Miller
Institute for Health and Aging, University of California, San Francisco 94109
JAMA 273:656-62. 1995..We recommend that simulation models should provide a range of estimates that better reflect both market trends and the profound uncertainty about the effects of health system reform...
- The hubris of health status measurement: a clarification of its role in the assessment of medical careN Goldfield
3M Health Information Systems Inc, Department of Health Services, Boston University School of Public Health, MA, USA
Int J Qual Health Care 8:115-23. 1996..The paper then provides different suggestions for dealing with this important issue. Most notably, a community based health status assessment is recommended...
- Managed competition: a health reform plan that "puts people first"C W Stenholm
U S House of Representatives Washington, DC
J Am Health Policy 3:15-8. 1993..President-elect Clinton should use the managed competition model as a blueprint for the health plan he has promised in the first 100 days in office...
- Reform in Washington stateS A Rubenstein
Group Health Cooperative of Puget Sound, Seattle, WA 98121
HMO Pract 8:26-9. 1994..The most dramatic observation is that the pace of change is far more rapid than our organization has experienced in recent years; and that pace of change is likely to continue for years to come...
- Managed cooperation, not competition: a proposal for implementing national health reformR C Coile
Health Forecasting Group, Santa Clarita, CA
Front Health Serv Manage 10:3-28; discussion 43-4. 1994..Structural and legal barriers to cooperation, such as antitrust and malpractice reform, should be reduced or eliminated to encourage collaborative initiatives under national health reform...
- What will future historians say about the Clinton health reform actN Goldfield
3M Health Information Systems, Wallingford, CT
Physician Exec 19:3-8. 1993..He calls himself a skeptic, not a cynic, saying that the likelihood of meaningful change is small, given the numerous proponents of the status quo...
- Federal official discusses reform. Interview by Debra MamorskyB C Vladeck
Health Care Financing Administration
J Health Care Benefits 3:37-42. 1993..The administrator of the Health Care Financing Administration discusses managed competition, the cost concerns of small and large employers under such a program, and what benefits managers must do in response to health care reform...
- Elements of the American Health Security Act of 1993K Fickenscher
Michigan State University Center for Medical Studies, Kalamazoo
Physician Exec 19:4-16. 1993..This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package...
- Managed competition in MinnesotaJ Klein
Minnesota Department of Employee Relations, St Paul, MN
Manag Care Q 1:58-67. 1993..The program's experience may offer insights into the potential success of managed competition in other settings...
- The iron triangle and the chrome pentagonR B Donker
Global Business Network, Emeryville, CA
Healthc Forum J 36:72-7. 1993..Like the arms race, the healthcare system is built on a framework of incentives driven by fear and finance--also like the arms race, it will not admit to piecemeal reform...
- Paying for efficiency: what price the quality of hospital care?A Shiell
Centre for Health Economics Research and Evaluation, Westmead Hospital
Aust J Public Health 16:294-301. 1992..If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care...
- Managed competitionV F Maher
Department of Health Care Programs, Iona College, New Rochelle, NY
Hosp Mater Manage Q 15:69-78. 1993....
- Medical group practice and President Clinton's health reform proposalsT P Weil
Bedford Health Associates, Inc, Asheville, NC 28801
Med Group Manage J 40:54-66; discussion 68-9. 1993..In addition, Austin Ross Jr., FACMGA, offers his many years of group practice experience through a commentary following Weil's article...
- Medical technology meets managed competitionD Durenberger
United States Senate
J Am Health Policy 3:23-8. 1993..The federal government can provide a safety valve for specific coverage decisions and can facilitate the acquisition, evaluation, and dissemination of information on new technologies...
- What'll ya have?S J Hage
Cedars Sinai Medical Center, Los Angeles
Radiol Manage 15:10-2. 1993..In the article, Mr. Hage describes two proposed financing approaches and tells why he thinks both of them miss the mark...
- Fixing the individual health insurance marketW R Jones
Aetna Life and Casualty
Benefits Q 9:52-8. 1993..The individual health insurance market is in crisis. Among the possible options for reform, a managed competition approach offers the broadest, most comprehensive solution...
- Aggressive regulator or passive price-taker: what role should HIPCs (health insurance purchasing cooperatives) play?E K Wicks
Institute for Health Policy Solutions, Washington, DC
J Am Health Policy 3:21-5. 1993..Policymakers must decide whether they want a HIPC to be an aggressive regulator--using its power to force changes among health plans--or a passive price-taker that contracts with plans meeting key criteria...
- The opportunity to do better: lessons old and new from Germany's health systemR A Knox
J Am Health Policy 3:37-48. 1993..New lessons, which are more concerned with operational strategies, include societal affordability, budgets, supply side restrictions, and volume controls...
- Battling for national health reformL DiVenere
National Association for Home Care
Caring 12:12-20, 22, 24-6. 1993..Who in Washington holds the ammunition to wage a winning war? Here is your insider's guide to the health reform leaders and their likely strategies. Be assured only that their battles will be intense...
- Purchasing coalitions and managed careT Hausner
Office of Managed Care, Health Care Financing Administration, Rockville, MD, USA
Manag Care Q 3:76-88. 1995..This article describes the types of managed care plans used by these coalitions and their arrangements with Medicare managed care...
- Physician collective bargaining: all eyes are on TexasJ L Quinn
Vinson and Elkins L L P, Austin, Texas, USA
J Health Law 33:141-55. 2000..Notwithstanding the intention of its drafters, it is likely that the law and its proposed regulations may only provide physicians with costly and time-consuming procedures that present multiple risks instead of renewed power...
- Coverage, Organization of Care, and Colorectal ScreeningEric Schneider; Fiscal Year: 2004..Results of this study can guide the enactment of health policies that will increase rates of colorectal cancer screening and thereby reduce the incidence of colorectal cancer and its associated morbidity and mortality. ..
- Massachusetts Quality E-Measure Validation StudyEric Schneider; Fiscal Year: 2007....