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Comparative Study
. 1993 Fall;15(1):7-23.

Do health maintenance organizations work for Medicare?

R S Brown  1 , D G Clement, J W Hill, S M Retchin, J W Bergeron
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Comparative Study

Do health maintenance organizations work for Medicare?

R S Brown et al. Health Care Financ Rev. 1993 Fall.

Abstract

Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.

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Figures

Figure 1
Figure 1. Areas Served, by Medicare Risk Plans and Levels of Enrollment: January 1992
See this image and copyright information in PMC

References

    1. Ash A, Porell F, Gruenberg L, et al. Adjusting Medicare Capitation Payments Using Prior Hospitalization Data. Health Care Financing Review. 1989 Aug;10(4):17–30. - PMC - PubMed
    1. Brown RS, Bergeron JW, Clement DG, et al. The Medicare Risk Program for HMOs—Final Summary Report on Findings from the Evaluation. Princeton: Mathematica Policy Research, Inc.; Feb, 1993. Contract Number 500-88-0006.
    1. Boles E. Insolvency in Managed Care Organizations: Financial Indicators. Topics in Health Care Financing. 1992 Winter;19(2):40–57. - PubMed
    1. Clement DG, Retchin SM, Stegall MH, Brown RS. Evaluation of Access and Satisfaction with Care in the TEFRA Program. Richmond: Williamson Institute for Health Studies; Oct, 1992.
    1. Hill JW, Brown RS. Biased Selection in the TEFRA HMO/CMP Program. Princeton: Mathematica Policy Research, Inc.; Sep, 1990.

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