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Factor affecting the choice between two prepaid plans.

This study examines the factors affecting the choice between two comprehensive prepaid plans of medical care available to the staff of Stanford University. One is a Kaiser plan, offered since 1969. Under the other (Clinic plan for short), medical services are provided by a predominantly fee-for-service group practice and hospital services are covered by a standard Blue Cross hospital policy; the Clinic plan has been available since the 1950s. The Kaiser plan has only a token copayment for office and home visit while the Clinic plan has a 25 per cent coinsurance provision applying to all physician and outpatient ancillary services. It was found that the two major factors affecting choice were income and distance to the provider. The preference for the Kaiser plan increased as income decreased. Similarly, as distance from the Clinic increased and distance from a Kaiser facility decreased, the preference for the Kaiser plan increased. However, proximity to the provider was a more important factor for the higher-income Clinic plan subscribers. The data also show that the longer availability of the Clinic plan had a long-term effect on enrollment. A substantial proportion of long time Stanford employees who might have been expected to prefer the Kaiser plan stayed with the Clinic plan.

Attitude to Health↗

Price and membership in a prepaid group medical practice.

Federal interest in prepaid group practices as a means to control rising health care costs in reviving. This article is an empirical study of price and membership at a prepaid group practice among employees of Yale University. This article is the first to estimate the effect of price on the decision for membership in a prepaid group. The probability of joining the prepaid group is estimated to be a function of the relative price of the prepaid group and a conventional third-party insurance plan, the distance of residence to the prepaid group, the perceived quality of services at the prepaid group and the demand for medical services. Our most important finding is that employees' choice is quite sensitive to the relative price of the two plans. This has important implications for federal policy toward prepaid group practices.

Blue Cross Blue Shield Insurance Plans↗

Trickle-down theory. Anthem's expensive acquisition of Trigon Healthcare raises question of whether local providers may end up with the bill.

Anthem's acquisition of Trigon Healthcare, its largest deal to date at $4 billion in cash and stock, gives the insurer a sturdy foothold in the Southeast while rewarding Trigon's shareholders with a profit. Anthem CEO Larry Glasscock (right) and Trigon CEO Thomas Snead expect a smooth transition. Anthem has taken a pricey step toward becoming the No. 1 Blues plan consolidator. But will local providers end up footing much of the bill?

Blue Cross Blue Shield Insurance Plans↗

The recovery of Bay State Health Care.

Blue Cross and Blue Shield of Massachusetts acquired Bay State Health Care after the HMO's tumultuous downturn. The case study described herein provides a useful lesson in the moves that must be made, particularly in an era of health care consolidation and intensive competition, to maintain health plan stability and reinforce its position in the marketplace.

Blue Cross Blue Shield Insurance Plans↗

A blue streak for managed care.

The nation;s Blue Cross and Blue Shield organizations have taken the lead in managed care. Enrollment in their 76 HMOs recently reached 7.6 million. By exploring the opportunity to go public and other options, the plans are looking for even more growth in the field.

Blue Cross Blue Shield Insurance Plans↗

Medicaid and Blue Cross DRG payment plans: a comparison.

Six states--Michigan, New Jersey, Ohio, Pennsylvania, Utah, and Washington--have enacted DRG-based Medicaid prospective payment plans. These systems closely parallel Medicare's due to the time and expense involved in developing and implementing an alternative case-mix payment method. A comparison of peer groups, capital costs, blend factors, outlier payments, medical education costs, etc., reveals similarities and differences in the plans that these states have adopted. Ten Blue Cross/Blue Shield plans have adopted prospective payment systems, mostly without setting DRG rates. These systems differ from Medicare and Medicaid DRG systems and from each other in a variety of ways. More state Medicaid programs probably will adopt prospective payment systems similar to Medicare's and Blue Cross/Blue Shield plans will continue to modify their hospital contracts. Hospitals' efforts to contain costs will be impeded if the major insurers within a state base their prospective payment systems on different product lines or units of output.

Blue Cross Blue Shield Insurance Plans↗