title: Scale and scope economies among health maintenance organizations.
abstract: We examine scale and scope economics among Group and IPA Health Maintenance Organizations (HMOs) over the period 1988 to 1991 using a national sample of HMOs. We allow for the multiproduct nature of HMO production by estimating the cost of producing a member month of non-Medicare and Medicare coverage, and we examine the effect of HMO market structure on costs. We find that HMOs benefit from scale economies. There are scope diseconomies associated with providing both non-Medicare and Medicare products. Group HMOs in more competitive markets have lower costs but IPA costs are not affected by competition.
authors.affiliation: Department of Social and Decision Sciences, Carnegie-Mellon University, Pittsburgh, PA 15213, USA.
authors.forename: D
authors.initials: D
authors.lastname: Wholey
authors.forename: R
authors.initials: R
authors.lastname: Feldman
authors.forename: J B
authors.initials: JB
authors.lastname: Christianson
authors.forename: J
authors.initials: J
authors.lastname: Engberg
mesh_terms: D004465:Economic Competition; D017598:Efficiency, Organizational / Q000191:economics; D005251:Fees, Medical; D006125:Group Practice, Prepaid / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D006302:Health Services Research; D007193:Independent Practice Associations / Q000191:economics; D016018:Least-Squares Analysis; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D014481:United States