Grantee Publication

The Stucture and Experience of State Risk Pools: 1988-1994

Medical Care Research and Reivew
Vol. 54, No. 2
April 1997
Stearns, S.C., Slifkin, R.T., Thorpe, K., and T.A. Mroz
pp. 223-38

State risk pools are state-sponsored plans for persons who want to buy health insurance but are medically uninsurable or unable to find policies at reasonable cost. This article reviews the structure of all pools and describes in more detail the experiences of eight pools. Although pools grew in number and size in the late 1980s, most pools subsequently stabilized in size. The eight risk pools studied had high enrollee turnover; and a small proportion of enrollees accounted for a large proportion of expenditures.

Physician Participation and NonParticipation in Medicaid Managed Care: The TennCare Experience

Southern Medical Journal
Vol. 92, No. 11
November 1999
Sloan, F.A., Conover, C., and P. Rankin
pp. 1064-70

BACKGROUND: TennCare is a significant state health reform effort, channeling all Medicaid recipients into managed care. We examined physician attitudes about TennCare. METHODS: In 1997, we surveyed a stratified random sample of Tennessee physicians using predominantly Likert-type scale questions. All physicians surveyed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/gynecology, neurosurgery, general surgery, and pediatrics.

Evolution and Early Evidence of the Impact of Consumer-Driven Health Plans: From E-Commerce Venture to Health Savings Accounts

Expert Review of Pharmacoeconomics and Outcomes Research-August 2008
Vol. 8, No. 4
August 2008
Parente, S. and R. Feldman
pp. 343-348(6)

Using results from peer-reviewed empirical analyses we describe the development and impact of the consumer-driven health plan market over the last 5 years. The results of these analyses show that consumers are responding to the financial incentives of these new health insurance benefits. Although the results may not always be what the consumer-driven health plan developers intended, there is clear evidence of `consumerism', where individuals act in a way that generally increases their access to healthcare or investments, if the opportunity is present.

The Effect of Medicare Health Maintenance Organizations on Hospitalization Rates for Ambulatory Care-Sensitive Conditions

Medical Care - October 2006
Vol. 44, No. 10
October 2006
Zeng, F., O'Leary, J.F., Sloss, E.M., Lopez, M.S., Dhanani, N., and G. Melnick
pp. 900-7

Objective: The objective of this study was to estimate the effect of Medicare Health Maintenance Organization (HMO) enrollment on hospitalization rates and total inpatient days for ambulatory care-sensitive conditions (ACSCs) after controlling for selection.

Research Design: Simultaneous equations using a discrete factor selection model are used to estimate the probability of HMO enrollment, hospitalization rates, and total inpatient days for ACSCs.

Topic: 
Managed Care
Topic: 
Medicare

Competition among Hospitals for HMO Business: Effect of Price and Nonprice Attributes

Health Services Research--May 2003
Vol. 37, No. 5
May 2003
Young, G.J., Burgess, J.F., and D. Valley
pp. 1267-89

OBJECTIVE: To investigate patterns of competition among hospitals for the business of health maintenance organizations (HMOs). The study focused on the relative importance of hospital price and nonprice attributes in the competition for HMO business. DATA SOURCES/STUDY SETTING: The study capitalized on hospital cost reports from Florida that are unique in their inclusion of financial data regarding HMO business activity. The time frame was 1992 to 1997. STUDY DESIGN: The study was designed as an observational investigation of acute care hospitals.

Topic: 
Acute Care
Topic: 
Managed Care

Inpatient Utilization by Dual Medicare-Medicaid Eligibles in Medicare Risk HMOs and Fee for Service, California, 1991-1996

Managed Care Interface-December 2004
Vol. 17, No. 12
December 2004
Sloss, E.M., Dhanani, N., O'Leary, J.F., Lopez, M.S., and G. Melnick
pp. 30-3, 40-1

Inpatient use among dual Medicare-Medicaid eligible beneficiaries in California Medicare HMOs and fee-for-service plans from 1991 to 1996 was compared, using a unique dataset that links Medicare enrollment data to inpatient discharge data. Dual eligibles in HMOs were found to have lower discharge rates, shorter lengths of stay, and fewer inpatient days than dual eligibles in the traditional fee-for-service system. Both, however, had higher discharge rates and inpatient days than non-dual-eligible beneficiaries.

Market Failures and the Evolution of State Regulation of Managed Care

Law and Contemporary Problems
Vol. 65, No. 4
Fall 2002
Sloan, F.A. and M.A. Hall
pp. 169-206

States have enacted numerous statutes in response to widespread dissatisfaction with managed care, which was exacerbated by its growth during the 1990s. Known as managed care patient care laws, the statutes address concerns of consumers and medical care providers.

Health Maintenance Organization Consolidations: How National Mergers Affect Local Markets

Health Affairs
Vol. 18, No. 4
July 1999
Feldman, R., Wholey, D., and J. Christianson
pp. 96-104

The health maintenance organization (HMO) industry has undergone a wave of national consolidations in recent years. The most notable among these were between United HealthCare and MetraHealth (1995), PacifiCare Health Systems and FHP International (1996), Aetna Life and Casualty and U.S. Healthcare (1996), and Aetna and Prudential's health care unit (1999). This paper examines HMO consolidation from 1994 to 1997, looking first at concentration at the national level and then at the consequences of national consolidations for local markets.

Hospital Pricing and the Uninsured: Do the Uninsured Pay Higher Prices?

Health Affairs-February 5, 2008
Vol. 27, No. 2
February 5, 2008
Melnick, G. and K. Fonkych
pp. w116-22

Although the health care pricing literature has grown substantially in recent years, there has been little empirical analysis of how hospital pricing behavior affects the uninsured. We use unique data from California to compare actual prices paid by uninsured patients with prices paid by commercial and Medicare patients. We find that uninsured patients pay prices similar to those of Medicare patients. Further, we find that despite increased media attention, hospital prices to the uninsured have risen in recent years.

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