title: Health plan competition in local markets.
abstract: OBJECTIVE
  To examine the structure of local health insurance markets and the strategies health plans were using to respond to competitive pressures in local markets in 1996/1997.
  
  
  METHODS
  Community Tracking Study site visits conducted between May 1996 and April 1997 in 12 U.S. markets selected to be nationally representative.
  
  
  METHODS
  In each site, 36 to 60 interviews on local health system change were conducted with healthcare industry informants representing health plans, providers, and purchasers.
  
  
  METHODS
  Relevant data for this article were abstracted from standardized protocols administered to multiple respondents in each site.
  
  
  RESULTS
  Although the competitive threat from national plans was pervasive, local plans in most sites continued to retain strong, often dominant, positions in historically concentrated markets. In all sites, in response to purchaser pressures for stable premiums and provider choice, and the threat of entry and to plans were using three strategies to increase market share and market power: (1) consolidation/geographic expansion, (2) price competition, and (3) product line/segment diversification that focused on broad networks and open-access products. In most markets, in response to the demand for provider choice, the trend was away from ownership and exclusive arrangements with providers.
  
  
  CONCLUSIONS
  Although local plans were moving to become full-service regional players, there was uncertainty about the abilities of all plans to sustain growth strategies at the expense of margins and organizational stability, and to effectively manage care with broad networks.
authors.affiliation: Center for Studying Health System Change, Washington, DC 20024, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Grossman
mesh_terms: D003153:Community Health Services / Q000458:organization & administration / Q000639:trends*; D004465:Economic Competition / Q000458:organization & administration / Q000639:trends*; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000639:trends; D006302:Health Services Research / Q000379:methods; D007373:Interinstitutional Relations; D018854:Managed Competition / Q000458:organization & administration / Q000639:trends; D008389:Marketing of Health Services / Q000458:organization & administration / Q000639:trends*; D020400:Provider-Sponsored Organizations / Q000458:organization & administration / Q000639:trends; D011897:Random Allocation; D014481:United States