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…

Measuring adverse selection in managed health care

Introduction  Much of health care today is paid for by managed care plans.  If the managed care plans are profit maximizers–which I assume them to be–then they face a tradeoff.  By offering a lower quality of care, they will make more money; but lowering the quality of care reduces the demand for their insurance product. …