S/HMO versus TEFRA HMO enrollees: analysis of expenditures.
This study compares expenditures on health care services for enrollees in a social health maintenance organization (S/HMO) and a Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA)-risk Medicare health maintenance organization (HMO). In addition to the traditional Medicare services covered by the TEFRA HMO, the S/HMO provided a long-term care (LTC) benefit and case management services for chronic illness. There do not appear to be any overall savings associated with S/HMO membership, including any savings from substitution of S/HMO-specific services for other, traditional services covered by both the S/HMO and the TEFRA HMO.
Dowd
B
B
Division of Health Services Research and Policy, University of Minnesota, 420 Delaware Street SE, Box 729 Mayo, Minneapolis, MN 55455, USA. dowdx001@tc.umn.edu
Hillson
S
S
VonSternberg
T
T
Fischer
L R
LR
D000368:Aged; D002204:Capitation Fee; D019090:Case Management; D002908:Chronic Disease / Q000191:economics; D003191:Comprehensive Health Care / Q000191:economics*; D017046:Cost Savings; D003625:Data Collection; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D006278:Medicare / Q000706:statistics & numerical data*; D020414:Risk Sharing, Financial; D013659:Tax Equity and Fiscal Responsibility Act; D014481:United States