Abstract
From 1977 to 1982, the admission rate in Minneapolis-St. Paul (Twin Cities) has been falling faster than the national average, and faster than the rate in selected comparison metropolitan areas. A natural question regards the impact of Twin Cities HMOs on decreased admission rates. This analysis shows that one's estimate of the HMO effect on total admission rates depends crucially on the estimated "spillover" effect, that is, the effect of HMOs on the non-HMO sector. Using secondary age-adjusted data, the analysis provides estimates of upper and lower bounds on the HMOs' effect on admission rates.
Full text
PDF











Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Christianson J. B., McClure W. Competition in the delivery of medical care. N Engl J Med. 1979 Oct 11;301(15):812–818. doi: 10.1056/NEJM197910113011504. [DOI] [PubMed] [Google Scholar]
- Dowd B., Feldman R. Biased selection in Twin Cities health plans. Adv Health Econ Health Serv Res. 1985;6:253–271. [PubMed] [Google Scholar]
- Goldberg L. G., Greenberg W. The competitive response of Blue Cross and Blue Shield to the health maintenance organization in Northern California and Hawaii. Med Care. 1979 Oct;17(10):1019–1028. doi: 10.1097/00005650-197910000-00005. [DOI] [PubMed] [Google Scholar]
- Jackson-Beeck M., Kleinman J. H. Evidence for self-selection among health maintenance organization enrollees. JAMA. 1983 Nov 25;250(20):2826–2829. [PubMed] [Google Scholar]
- Luft H. S. Assessing the evidence on HMO performance. Milbank Mem Fund Q Health Soc. 1980 Fall;58(4):501–536. [PubMed] [Google Scholar]
- 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]
- Welch W. P. Regression toward the mean in medical care costs. Implications for biased selection in health maintenance organizations. Med Care. 1985 Nov;23(11):1234–1241. doi: 10.1097/00005650-198511000-00002. [DOI] [PubMed] [Google Scholar]