Findings Brief

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Much of the debate about capitating individual physicians for their services pits the researchers and policymakers who say that it reduces health care costs against those who declare that it hampers quality of care. A recent study led by Terry Field, Sc.D., and conducted at the University of Massachusetts Medical
Center finds that financial pressures do not lead to significant changes in physician behavior.

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A team of researchers led by Jack Hadley, Ph.D., of Georgetown Institute for Health Care Policy and Research (IHCPR), and including Darrell Gaskin, Ph.D., also of the IHCPR, Kevin Schulman, M.D., of the Georgetown University Medical Center, and Jose Escarce, M.D., Ph.D., of RAND, have examined the processes employed by MCOs during contract negotiations with tertiary care hospitals.

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A new project from the University of Minnesota and The University of Pennsylvania offers fresh insights into the relationship between hospital consolidation, the managed care environment, and consumer welfare. Robert Town; Ph.D.,Douglas Wholey Ph.D., and Roger Feldman Ph.D., in collaboration with Lawson R. Burns Ph.D., conducted two related analyses,the first examining the relationship between managed care and hospital consolidation, and the second examining the impact of hospital consolidation on consumers.

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Linda J. Blumberg, Ph.D., of the Urban Institute and her colleagues Amy Davidoff, Ph.D.; Len Nichols, Ph.D.; and Bowen Garrett, Ph.D., found that many specific factors influence whether insurance is offered or taken up among this population. They also discovered that policies to reduce the number of employed individuals who lack coverage are most likely to be effective if targeted at specific subgroups of workers and employers.

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Only a minority of U.S. children and adolescents who need mental health care are receiving mental health services. Such discrepancies in care appear to vary significantly on a state-by-state basis, according to new HCFO-sponsored research, and the differences across states are not explained by sociodemographic characteristics such as race and income. Roland Sturm, Ph.D., and Jeanne Ringel, Ph.D., both at RAND, recently completed a study examining differences in mental health need and services use among children and adolescents across 13 states.

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Impressed by the successes of managed care in the private sector, many states in the 1990s began to move their Medicaid populations from fee-for-service (FFS) into managed care. They hoped to not only control costs, but also improve access to care, utilization, and patient satisfaction. Between 1996 and 1998, the number of Medicaid recipients covered by managed care plans grew by nearly 3.5 million, from 40 percent of all recipients to nearly 54 percent. Despite this growth, little is known about the effects of Medicaid managed care on health care access and use.

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Gatekeeping — a system in which health plan enrollees choose a primary care physician (PCP) as a de-facto services utilization manager and consultant to make decisions regarding the need for specialty providers and services — is a term that is widely recognized within the context of managed health care. But how well the public understands both the objectives of gatekeeping and its effects on health care delivery, is not widely known.

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The health care safety net—which includes public hospitals, community health centers, local clinics, and some primary health care physicians—is “crowding out” (replacing) other insurance options for unmarried childless adults nationally, according to new research by Anthony Lo Sasso, Ph.D., and colleagues at Northwestern University.

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Promising new medical treatments for life threatening diseases often inspire hope, patient demand, and physician enthusiasm before evaluation. In the late 1980s, highdose chemotherapy/autologous bone marrow transplantation (HDC/ABMT) emerged as a promising medical procedure for treating metastatic and high-risk breast cancer. But procedures, unlike new drugs, face no requirement for evaluation by randomized clinical trials (RCTs). In the early 1990s, HDC/ABMT began diffusing rapidly and widely into clinical practice concurrent with much slower evaluation by RCTs.

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Prescription drugs are consistently mentioned in discussions about rising health care costs as a primary factor driving expenditures. Plans, purchasers, and policymakers are perusing promising strategies to reduce pharmaceutical spending while maintaining quality. One such approach separates drugs into “tiers” based on price levels and creates a financial incentive—in the form of a lower co-payment—for individuals to make the lowest cost selections.