Do health maintenance organizations work for Medicare?
Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.
Mathematica Policy Research, Plainsboro, NJ 08536.
R S
RS
Brown
D G
DG
Clement
J W
JW
Hill
S M
SM
Retchin
J W
JW
Bergeron
D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D003258:Consumer Behavior; D017046:Cost Savings / Q000379:methods; D003625:Data Collection; D006279:Health Maintenance Organizations / Q000191:economics* / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006278:Medicare / Q000458:organization & administration*; D015397:Program Evaluation / Q000191:economics / Q000706:statistics & numerical data; D012306:Risk; D016896:Treatment Outcome; D014481:United States