Medicare Advantage funding to be cut

David Whelan chronicles the rise (and possibly future fall) of Medicare Advantage programs in his article “Unfilled Prescription” in Forbes. Earlier laws privatizing Medicare, starting with a pilot program in 1985, were written to give insurance companies only 95% of the money otherwise spent per Medicare member. The insurers were supposed to figure out how…

Consumer Channeling and Preferred Providers

Doctors often complain that health insurers are squeezing their profit margins. These insurers offer the physicians access to patients as part of their network in exchange for discounted fees. Physicians can decide not to join the network and charge higher prices, but may be left with fewer patients. The bargaining power of the health insurer…

Laurence Baker

Laurence Baker is a health economist at Stanford’s Center for Health Policy. Much of Mr. Baker’s work has dealt with how HMOs have affected care levels. Today I will briefly review three of Baker’s articles: HMO Penetration and the Cost of Health Care (AER 1996) In this paper, Baker and Corts look how HMO market…

Patient Cost-Sharing, Hospitalization Offsets, and the Design of Optimal Health Insurance for the Elderly

The RAND health insurance experiment (HIE) demonstrated that increasing coinsurance rates decreases medical care utilization. The HIE also found that health outcomes did not vary between individuals with high, low and zero coinsurance rates. A working paper by Chandra, Gruber and McKnight (“Patient Cost Sharing…“) re-examines whether or not this is the case using a…

Getting Doctors to Compete

There is an interesting post at GoozNews (“Getting Doctors to Compete“) in which Merrill Goozner comments on Harvard Business School professor Michael Porter’s belief that competition and integrated care are the solutions to the nation’s health care woes. “Where we need to go is an integrated practice model,” he said. His model entails patient-focused practice…

Defining Managed Care

As insurance markets began to develop in the U.S., we observed two types of insurance emerging: indemnity plans and health maintenance organizations (HMOs).  Indemnity plans compensated providers on a fee-for-service basis and HMOs used a capitation scheme.  Typically, HMOs used gatekeepers to restrict services while indemnity plan restrictions were few and far between.  Typical analysis…

Physician Selection

Health economists frequently examine the effect of physician payment method on the provision of medical services.  It is often found that patients whose doctors are compensated via capitation or salaried schemes receive fewer services than patients whose doctors are compensated through a fee for service mechanism.  This finding is robust to a variety of medical settings…

Information on Referrals

Years ago, when someone needed care from a doctor they visited the physician directly whether they were a general practitioner or a specialist.  Nowadays, it is rarer for patients to visit a specialist without a referral.  The typical referral comes from a primary care physician, but it is also common for a specialist to refer…