Table 4. Method of Ratesetting, by Product Type.
| Type of Ratesetting | All BCBSA | BCBSA Traditional | BCBSA PPO | BCBSA HMO | BCBSA POS | Medicaid | Other HMO |
|---|---|---|---|---|---|---|---|
| Number | |||||||
| Negotiation | 31 | 8 | 8 | 10 | 5 | 0 | 0 |
| Hospital-Specific Cost | 15 | 7 | 3 | 3 | 2 | 8 | 2 |
| Peer Group | 18 | 5 | 4 | 6 | 3 | 6 | 2 |
| Formula | 2 | 1 | 0 | 1 | 0 | 3 | 0 |
| Mixed/Other | 23 | 9 | 8 | 4 | 2 | 4 | 1 |
| Total | 89 | 30 | 23 | 24 | 12 | 21 | 5 |
| Missing | 11 | 2 | 4 | 1 | 4 | 0 | 0 |
| Percent | |||||||
| Negotiation | 35 | 27 | 35 | 42 | 42 | 0 | 0 |
| Hospital-Specific Cost | 17 | 23 | 13 | 12 | 17 | 38 | 40 |
| Peer Group | 20 | 17 | 17 | 25 | 25 | 29 | 40 |
| Formula | 2 | 3 | 0 | 4 | 0 | 14 | 0 |
| Mixed/Other | 26 | 30 | 35 | 17 | 18 | 19 | 20 |
| Total | 100 | 100 | 100 | 100 | 100 | 100 | 100 |
NOTES: BCBSA is Blue Cross and Blue Shield Association. PPO is preferred provider organization. HMO is health maintenance organization. POS is point-of-service.
SOURCE: Carter, G.M., Jacobson, P.D., Kominski, G.F., and Perry, M.J., RAND, 1994.