From Movement To Industry: The Growth Of HMOs

Gruber, Lynn R.; Shadle, Maureen; Polich, Cynthia Longseth

doi:10.1377/hlthaff.7.3.197

Cited by 56 publications

(21 citation statements)

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“…Some have suggested (usually derisively) that because of the proliferation of acronyms, the U.S. health insurance market became an unintelligible alphabet soup of "three-letter health plans." Moreover, this soup proved to be primordial; mergers, acquisitions, and tough competition led to a fast-paced evolution and hybridization of the first generation of plans, complicating matters further (Hoy et al 1991;Gruber et al 1988; Hale and Hunter 1988;Gabel et al 1989;Gold 1991).…”

Section: A Decade Of Transitionmentioning

confidence: 99%

Razing a Tower of Babel: A Taxonomy for Managed Care and Health Insurance Plans

Weiner

Lissovoy²

1993

Journal of Health Politics, Policy and Law

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To many, the U.S. health care system has become an unintelligible alphabet soup of three-letter health plans. There is little agreement about which characteristics distinguish one type of plan from another. In this article we chip away at what has become a Tower of Babel of managed care and health insurance terminology. We review past and current trends in the market for nontraditional health benefit plans and propose a taxonomy, or system of classification, that will aid in understanding how managed care plans differ from conventional health insurance and from one another. Also included is a comprehensive glossary of terms.

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Section: A Decade Of Transitionmentioning

confidence: 99%

Razing a Tower of Babel: A Taxonomy for Managed Care and Health Insurance Plans

Weiner

Lissovoy²

1993

Journal of Health Politics, Policy and Law

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“…Together, these efforts to limit the growth of prepaid practice were largely successful, preventing the establishment of more than a handful of prepaid practices (fewer than 40) through the 1960s (Gruber, Shadle and Polich, 1988;IOM, 1993). In the 1950s and 1960s, court and legislative decisions gradually relaxed these restrictions on physician practice, and most studies find no evidence that remaining state legislation limited HMO formation subsequently (Goldberg and Greenberg, 1981;Morrissey and Ashby, 1982; but see Welch 1985 for some contrary evidence).…”

Section: History Of Managed Carementioning

confidence: 99%

Managed Care

Glied¹

1999

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By 1993, over 70% of all Americans with health insurance were enrolled in some form of managed care plan. The term managed care encompasses a diverse array of institutional arrangements, which combine various sets of mechanisms, that, in turn, have changed over time. The chapter reviews these mechanims, which, in addition to the methods employed by traditional insurance plans, include the selection and organization of providers, the choice of payment methods (including capitation and salary payment), and the monitoring of service utilization.Managed care has a long history. For an extended period, this form of organization was discouraged by a hostile regulatory environment. Since the early 1980s, however, managed care has grown dramatically. Neither theoretical nor empirical research have yet provided an explanation for this pattern of growth. The growth of managed care may be due to this organizational form's relative success in responding to underlying market failures in the health care system -asymmetric information about health risks, moral hazard, limited information on quality, and limited industry competitiveness.The chapter next explores managed care's response to each of these problems.The chapter then turns to empirical research on managed care. Managed care plans appear to attract a population that is somewhat lower cost than that enrolled in conventional insurance. This complicates analysis of the effect of managed care on utilization. Nonetheless, many studies suggest that managed care plans reduce the rate of health care utilization somewhat. Less evidence exists on their effect on overall health care costs and cost growth.

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“…Moreover, despite rapid percentage growth in the 1970s, as late as 1980 there were still only 9 million HMO enrollees, even though many business and government leaders increasingly recognized that health care expenditures were climbing much more rapidly than many other expenditures and even though the federal government undertook some limited initiatives to speed the creation of new HMOs (13,20).…”

Section: Managed Care Plans Before 1980mentioning

confidence: 99%