Skip to main content
NCBI home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1991 Nov;155(5):533–537.

Managed-care plans. Their future under national health insurance.

T P Weil 1
PMCID: PMC1003082  PMID: 1815407

Abstract

The nation's health maintenance organizations, preferred-provider organizations, independent practice associations, and similar managed-care efforts are not well positioned to take a leadership role in a nationwide universal access or national health insurance plan. They--with the possible exception of some large staff and group health maintenance organizations--have been unable to show uniformly that they can contain costs, provide better access or higher quality of care, and achieve greater patient satisfaction than fee-for-service endeavors. As the United States pursues universal access as a step toward national health insurance, the managed-care plans will continue to increase their numbers of subscribers. They will not, however, be able to enroll large numbers of the young, low-income employees and their dependents who account for most of the 63 million people uninsured sometime during each year. Under national health insurance, there might be an option for some health maintenance organizations to negotiate capitated payments. The vast majority of the nation's physicians, however, will reluctantly embrace a centrally managed fee-for-service approach rather than a salary or capitated reimbursement method, leaving only a trace of the competitive managed-care plan theme in a future, primarily monolithic, national health care system.

Full text

PDF
533

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson M. D., Fox P. D. Lessons learned from Medicaid managed care approaches. Health Aff (Millwood) 1987 Spring;6(1):71–86. doi: 10.1377/hlthaff.6.1.71. [DOI] [PubMed] [Google Scholar]
  2. Blendon R. J., Donelan K. The public and the emerging debate over national health insurance. N Engl J Med. 1990 Jul 19;323(3):208–212. doi: 10.1056/NEJM199007193230329. [DOI] [PubMed] [Google Scholar]
  3. Brown L. D. The medically uninsured: problems, policies, and politics. J Health Polit Policy Law. 1990 Summer;15(2):413–426. doi: 10.1215/03616878-15-2-413. [DOI] [PubMed] [Google Scholar]
  4. Burkett G. L. Variations in physician utilization patterns in a capitation payment IPA-HMO. Med Care. 1982 Nov;20(11):1128–1139. doi: 10.1097/00005650-198211000-00007. [DOI] [PubMed] [Google Scholar]
  5. Davies A. R., Ware J. E., Jr, Brook R. H., Peterson J. R., Newhouse J. P. Consumer acceptance of prepaid and fee-for-service medical care: results from a randomized controlled trial. Health Serv Res. 1986 Aug;21(3):429–452. [PMC free article] [PubMed] [Google Scholar]
  6. Enthoven A., Kronick R. A consumer-choice health plan for the 1990s. Universal health insurance in a system designed to promote quality and economy (1). N Engl J Med. 1989 Jan 5;320(1):29–37. doi: 10.1056/NEJM198901053200106. [DOI] [PubMed] [Google Scholar]
  7. Evans R. G., Lomas J., Barer M. L., Labelle R. J., Fooks C., Stoddart G. L., Anderson G. M., Feeny D., Gafni A., Torrance G. W. Controlling health expenditures--the Canadian reality. N Engl J Med. 1989 Mar 2;320(9):571–577. doi: 10.1056/NEJM198903023200906. [DOI] [PubMed] [Google Scholar]
  8. Feldman R., Dowd B., McCann D., Johnson A. The competitive impact of health maintenance organizations on hospital finances: an exploratory study. J Health Polit Policy Law. 1986 Winter;10(4):675–697. doi: 10.1215/03616878-10-4-675. [DOI] [PubMed] [Google Scholar]
  9. Hillman A. L. Financial incentives for physicians in HMOs. Is there a conflict of interest? N Engl J Med. 1987 Dec 31;317(27):1743–1748. doi: 10.1056/NEJM198712313172725. [DOI] [PubMed] [Google Scholar]
  10. Holahan J. Foundations for medical care: an empirical investigation of the delivery of health services to a medicaid population. Inquiry. 1977 Dec;14(4):352–368. [PubMed] [Google Scholar]
  11. Hornbrook M. C., Berki S. E. Practice mode and payment method. Effects on use, costs, quality, and access. Med Care. 1985 May;23(5):484–511. doi: 10.1097/00005650-198505000-00011. [DOI] [PubMed] [Google Scholar]
  12. Johnson A. N., Aquilina D. The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul. J Health Polit Policy Law. 1986 Winter;10(4):659–674. doi: 10.1215/03616878-10-4-659. [DOI] [PubMed] [Google Scholar]
  13. Kinzer D. M. Universal entitlement to health care. Can we get there from here? N Engl J Med. 1990 Feb 15;322(7):467–470. doi: 10.1056/NEJM199002153220711. [DOI] [PubMed] [Google Scholar]
  14. Langwell K. M., Hadley J. P. Insights from the Medicare HMO demonstrations. Health Aff (Millwood) 1990 Spring;9(1):74–84. doi: 10.1377/hlthaff.9.1.74. [DOI] [PubMed] [Google Scholar]
  15. Langwell K., Rossiter L., Brown R., Nelson L., Nelson S., Berman K. Early experience of health maintenance organizations under Medicare competition demonstrations. Health Care Financ Rev. 1987 Spring;8(3):37–55. [PMC free article] [PubMed] [Google Scholar]
  16. Laudicina S. S. State health risk pools: insuring the 'uninsurable'. Health Aff (Millwood) 1988 Fall;7(4):97–104. doi: 10.1377/hlthaff.7.4.97. [DOI] [PubMed] [Google Scholar]
  17. Luft H. S. HMOs and the quality of care. Inquiry. 1988 Spring;25(1):147–156. [PubMed] [Google Scholar]
  18. Luft H. S. How do health-maintenance organizations achieve their "savings"? N Engl J Med. 1978 Jun 15;298(24):1336–1343. doi: 10.1056/NEJM197806152982404. [DOI] [PubMed] [Google Scholar]
  19. Luft H. S., Maerki S. C., Trauner J. B. The competitive effects of health maintenance organizations: another look at the evidence from Hawaii, Rochester, and Minneapolis/St. Paul. J Health Polit Policy Law. 1986 Winter;10(4):625–658. doi: 10.1215/03616878-10-4-625. [DOI] [PubMed] [Google Scholar]
  20. Luft H. S., Miller R. H. Patient selection in a competitive health care system. Health Aff (Millwood) 1988 Summer;7(3):97–119. doi: 10.1377/hlthaff.7.3.97. [DOI] [PubMed] [Google Scholar]
  21. Manning W. G., Leibowitz A., Goldberg G. A., Rogers W. H., Newhouse J. P. A controlled trial of the effect of a prepaid group practice on use of services. N Engl J Med. 1984 Jun 7;310(23):1505–1510. doi: 10.1056/NEJM198406073102305. [DOI] [PubMed] [Google Scholar]
  22. McLaughlin C. G. HMO growth and hospital expenses and use: a simultaneous-equation approach. Health Serv Res. 1987 Jun;22(2):183–205. [PMC free article] [PubMed] [Google Scholar]
  23. Rice T., Gabel J., de Lissovoy G. PPOs: the employer perspective. J Health Polit Policy Law. 1989 Summer;14(2):367–382. doi: 10.1215/03616878-14-2-367. [DOI] [PubMed] [Google Scholar]
  24. Rossiter L. F., Langwell K. Medicare's two systems for paying providers. Health Aff (Millwood) 1988 Summer;7(3):120–132. doi: 10.1377/hlthaff.7.3.120. [DOI] [PubMed] [Google Scholar]
  25. Starr P. Transformation of defeat: the changing objectives of national health insurance, 1915-1980. Am J Public Health. 1982 Jan;72(1):78–88. doi: 10.2105/ajph.72.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Todd J. S. It is time for universal access, not universal insurance. N Engl J Med. 1989 Jul 6;321(1):46–47. doi: 10.1056/NEJM198907063210109. [DOI] [PubMed] [Google Scholar]
  27. Wagner E. H., Bledsoe T. The Rand Health Insurance Experiment and HMOs. Med Care. 1990 Mar;28(3):191–200. doi: 10.1097/00005650-199003000-00001. [DOI] [PubMed] [Google Scholar]
  28. Ware J. E., Jr, Brook R. H., Rogers W. H., Keeler E. B., Davies A. R., Sherbourne C. D., Goldberg G. A., Camp P., Newhouse J. P. Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care. Lancet. 1986 May 3;1(8488):1017–1022. doi: 10.1016/s0140-6736(86)91282-1. [DOI] [PubMed] [Google Scholar]
  29. Wilensky G. R., Rossiter L. F. Patient self-selection in HMOs. Health Aff (Millwood) 1986 Spring;5(1):66–80. doi: 10.1377/hlthaff.5.1.66. [DOI] [PubMed] [Google Scholar]
  30. Woolhandler S., Himmelstein D. U. A national health program: northern light at the end of the tunnel. JAMA. 1989 Oct 20;262(15):2136–2137. [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES