Trends in managed care and managed competition, 1993-1997

According to the recent literature, we are experiencing a managed care "revolution," and managed competition is increasingly being embraced by private- and public-sector policymakers. Using two large employer health insurance surveys, this paper presents new estimates that both confirm and add to our understanding of changes taking place in employment-based health plans. The dramatic shifts in enrollment from indemnity to managed care largely reflect employers' choices about the types of plans to offer. Employees are limited in the number and types of plans from which they can choose. When choice is available, it is generally not governed by managed competition principles.     

Mounting pressures: physicians serving Medicaid patients and the uninsured, 1997-2001

The proportion of doctors providing any charity care decreased from 76.3 percent in 1997 to 71.5 percent in 2001, according to a new study by the Center for Studying Health System Change (HSC). The proportion of physicians serving Medicaid patients also decreased from 87.1 percent in 1997 to 85.4 percent in 2001. The small decrease in physicians serving Medicaid patients does not appear to have had any negative effects on access to physicians among Medicaid beneficiaries. On the other hand, the more sizable decrease in physicians providing charity care is consistent with other evidence showing decreased access to physicians by uninsured persons. New budget pressures could lead states to freeze or cut Medicaid provider payment rates, which could then trigger access problems.     

The insurance gap and minority health care, 1997-2001

Gaps in access to medical care among working-age white Americans, African Americans and Latinos failed to improve between 1997 and 2001, despite a booming economy and increased national attention to narrowing and eliminating minority health disparities. African Americans and Latinos continue to have less access to a regular health care provider, see a doctor less often and lag behind whites in seeing specialists, according to recent findings from the Center for Studying Health System Change (HSC). Ethnic and racial disparities in access among uninsured Americans are much greater than disparities among the insured. Uninsured whites' greater financial resources may explain why they have fewer problems accessing care. Eliminating disparities in minority health care will be difficult without first eliminating these gaps in minority health insurance.     

No exodus: physicians and managed care networks

After remaining stable since 1996-97, the percentage of U.S. physicians who do not contract with managed care plans rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05, according to a national study from the Center for Studying Health System Change (HSC). While physicians have not left managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians. The increase in physicians without managed care contracts was broad-based across specialties and other physician and practice characteristics. Compared with physicians who have one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States. The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.     

Treading water: Americans' access to needed medical care, 1997-2001

Despite unprecedented economic growth, low unemployment and fewer uninsured people, Americans' ability to get needed medical care failed to improve significantly between 1997 and 2001, according to findings from the Center for Studying Health System Change's HSC) Community Tracking Study Household Survey. While most people get the care they believe they need, about one in seven Americans reported some difficulty obtaining needed care in 2001 - about the same as in 1997. At the same time, health system-related problems - such as the ability to get timely appointments - increased, suggesting possible health system capacity constraints are emerging. On a brighter note, children's ability to get needed care improved.     

Educating physicians in managed care

Mullikin Medical Centers, Fallon Clinic, Henry Ford Health System, and other advanced integrated systems have added a new dimension to continuing medical education. They're training physicians in capitation, referral management, practice guidelines, and other basic skills of a managed care practice. Learn why they do it--and how.     

Trends in Medicare home health care use: 1997-2001

The Balanced Budget Act of 1997 mandated a major overhaul in Medicare payment for home health care with an interim payment system (IPS) preceding a prospective payment system (PPS). This study extends an earlier analysis of the impact of the IPS to determine whether home health use and spendingtrends changed after the introduction of the PPS. The rapid decline in the incidence of use and visits per user under the IPS slowed in its final year and then picked up again in the first year of the PPS. In addition, average payment per visit increased sharply under the PPS. Little is known about the impact of continued large reductions in home health services since 1999.     

Suicide among Hispanics--United States, 1997-2001

By 2020, Hispanics are expected to represent 17% of the U.S. population and to surpass all other racial/ethnic minority populations in size. In 1996, the U.S. Department of Health and Human Services established the Hispanic Agenda for Action initiative; a major goal of this initiative is to identify health problems that affect Hispanics. In 2001, although the overall age-adjusted suicide rate per 100,000 population among Hispanics was lower than the U.S. national rate (10.7), suicide was the third leading cause of death among young (i.e., aged 10-24 years) Hispanics and the seventh leading cause of years of potential life lost before age 75 years. To identify demographic groups at risk for suicide and to help guide prevention efforts, CDC analyzed mortality data for 1997-2001. This report summarizes the results of that analysis, which indicated that, among Hispanics, the largest proportion of suicides occurred among young persons; suicide rates were higher among males; and the most common method of suicide was by firearms. To reduce the number of suicides, additional prevention strategies are needed, including 1) improving methods for collecting data about suicides, suicide attempts, and related behaviors; 2) expanding evaluation of prevention efforts aimed at reducing suicidal behaviors; and 3) examining how effective interventions can be modified for diverse and culturally specific populations.     

The impact of managed care on physicians.

This article investigates physicians' perceptions of how managed care has affected them, using data from a 1995 survey of Arizona physicians. Respondents report that participation in managed care has had significant and largely unpleasant effects on numerous aspects of medical practice: physician-patient relationships, clinical decision making, work conditions and settings, and overall satisfaction.     

Working families' health insurance coverage, 1997-2001

Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.     

Profiling primary care physicians for a new managed care network.

We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.     

Caring for patients under Medicaid mandatory managed care: perspectives of primary care physicians

The purpose of the study was to describe the experiences of primary care physicians caring for Medicaid recipients in a demonstration mandatory health maintenance organization (HMO) managed care program. The authors collected data through semistructured individual or focus group interviews with 14 physicians and through interviews with the chief executive officers of the three HMOs participating in the demonstration program. Interview questions, developed initially from a review of the literature, addressed physicians' experiences as primary care providers for Medicaid recipients under traditional fee-for-service and under managed care arrangements through the demonstration program. Four themes emerged: providers' hassles and burdens, the complex needs of Medicaid patients, improved access to care under managed care, and individual providers' disconnect from the processes of health policy implementation and program evaluation.