title: Managed care as a public cost-containment mechanism.
abstract: This article identifies the impact of managed-care reforms on the utilization of medical services within the military health-services system.  The data come from a recent demonstration project that substituted an HMO and PPO for traditional FFS arrangements.  Results from a semiparametric model indicate that the generosity of benefits in the HMO increased demand for ambulatory services.  Unlike the private-sector experience with managed care, aggressive utilization review did not significantly curtail inpatient stays.  These results vitiate the presumed effectiveness of reform strategies that rely on large, geographically diffused managed-care networks to contain public-sector health costs.
authors.forename: D P
authors.initials: DP
authors.lastname: Goldman
mesh_terms: D003363:Cost Control; D006264:Health Benefit Plans, Employee; D017048:Health Care Costs; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D008329:Managed Care Programs / Q000706:statistics & numerical data; D017059:Models, Econometric; D015983:Selection Bias; D014481:United States; D014600:Utilization Review