title: Potential effects of managed competition in rural areas.
abstract: This article assesses the extent to which managed competition could be successful in rural areas. Using 1990 Medicare hospital patient origin data, over 8 million rural residents were found to live in areas potentially without provider choice. Almost all of these areas were served by providers who compete for other segments of their market. Restricting use of out-of-State providers would severely limit opportunities for choice. These findings suggest that most residents of rural States would receive cost benefits from a managed competition system if purchasing alliances are carefully defined, but consideration should be given to boundary issues when forming alliances.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill 27599, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Slifkin
authors.forename: T C
authors.initials: TC
authors.lastname: Ricketts
authors.forename: H A
authors.initials: HA
authors.lastname: Howard
mesh_terms: D002391:Catchment Area, Health / Q000191:economics*; D003256:Community Participation; D017754:Group Purchasing; D019538:Health Care Surveys / Q000379:methods; D006297:Health Services Accessibility; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D015271:Insurance Pools; D018854:Managed Competition / Q000706:statistics & numerical data*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D019035:Rural Health Services / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D014481:United States