The role of managed care "products" in managed care "plans".
This paper presents information about the form and structure of managed care products offered by group/staff health maintenance organizations (HMOs), network/independent practice association (IPA) HMOs, and preferred provider organizations (PPOs). The information comes from a 1994 national survey of managed care plans and their arrangements with physicians. The findings confirm that multiple product offerings are now common in managed care plans. The two reasons plans most often cite for including these expanded offerings are to respond to customer interest and to ease the transition to more traditional managed care. Though plans commonly use a consistent provider network for different products, they also vary some arrangements with physicians across their products and pay them in different ways. We discuss the implications of our findings-the most comprehensive study of these issues to date-to aid in understanding the evolution of markets and of managed care, and as a basis for the design of future research and the databases it will require.
Gold
M
M
Mathematica Policy Research, Washington, DC 20024-2512, USA.
Hurley
R
R
D003625:Data Collection; D004465:Economic Competition; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D007193:Independent Practice Associations / Q000458:organization & administration / Q000706:statistics & numerical data; D017146:Models, Organizational; D011243:Preferred Provider Organizations / Q000458:organization & administration* / Q000706:statistics & numerical data; D011357:Product Line Management / Q000706:statistics & numerical data* / Q000639:trends; D011897:Random Allocation; D012017:Referral and Consultation; D014481:United States