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PubMed1997

Health care reform, managed competition, and the urban medically underserved: some preliminary questions about structure, equity, and quality care.

The purpose of this article is to provide some preliminary observations and discussion on several questions relating to managed competition in health and the urban medically underserved. The shift to managed competition in health care financing and delivery from an unmanaged fee-for-service system raises several critical transitional questions for those groups in the urban arena that have been traditionally medically underserved. After an overview discussion of cost dynamics in the American health care system and selected characteristics of the health care system and the urban medically underserved, the article explores several critical transitional questions relating to structure, equity and quality care considerations in managed competition and the urban medically underserved.

Demography↗
PubMedDate not supplied

Marketing strategies in a competitive managed care environment.

In the new health care marketplace dominated by managed care, patients expect more from their physicians and other providers. Because cost is not an issue for the managed care patient, physicians must find a way to distinguish their practices from others in the managed care plan directory. This article provides low-cost strategies that physicians may use to do so. These include: focusing on the customer; ensuring friendly, attentive, and trained staff using patient-friendly office policies; making the patient priority number one; listening to and communicating with patients; being a patient advocate; giving patients choices to increase their control over their care; respecting the time demands on the patient and his or her family, and others.

Communication↗
PubMed1996

Modifying managed competition to address cost and quality.

California's health care marketplace is undergoing rapid transformation--from one characterized by aggressive but unregulated competition to one that approximates managed competition. The Pacific Business Group on Health purchases health insurance for large employers; the California Public Employees Retirement System acts as a purchasing pool for both state workers and smaller public employers; and The Health Insurance Plan of California is a pool for small employers. Each focuses on price-conscious competition among health maintenance organizations. These large purchasing cooperatives also are addressing biased selection among the health plans they offer. Initially focused on simple demographic adjustments, risk adjustment now also entails adjustment for high-risk cases, such as acquired immunodeficiency syndrome (AIDS) and liver transplants. These purchasers also devote more detailed attention to the quality and process of care.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Managed competition: a critical analysis.

Proposals for managed competition offered by President Clinton and members of Congress would foster the proliferation of health maintenance organizations, which in turn could increase bureaucracy, reduce patients' choice of providers, restrict providers' medical practices, and benefit already profitable insurance companies. A single-payer alternative presents a more viable way of reducing administrative costs and providing health insurance for all.

Competitive Medical Plans↗
PubMed1994

Purchaser/provider separation and managed competition: reform options for Australia's health system.

A purchaser/provider separation and managed competition have been recommended as options for reform of Australia's health system. This paper presents the theoretical basis and supposed advantages of each model. The introduction of the purchaser/provider separation in the United Kingdom and New Zealand is described, as are the proposals for implementation of managed competition in the United States and the Netherlands. The potential for either model to deliver its promised benefits is critically evaluated in the light of existing evidence. As yet neither model can command unqualified support but both are worthy of further consideration.

Australia↗
PubMed1997

Academic faculty practices: issues for viability in competitive managed care markets.

This study compares the perspectives of eighteen managed care executives and twenty-four faculty practice executives on critical policy issues related to the managed care marketplace. Market sites studied in 1994 included four major metropolitan areas: Minneapolis-St. Paul, Los Angeles, Philadelphia, and Atlanta. These markets were selected as being representative of communities with descending degrees of managed care involvement, but with significant market activity. Study participants from both managed care systems and faculty practices examined five policy issues: (1) the importance of including academic medical centers in current and future health care plans for marketing purposes; (2) the provision of clinical services that are unique to the academic medical center, that is, unavailable elsewhere in the community; (3) the degree of financial supplement that employers might pay for including an academic medical center; (4) future restructuring of organizations to sustain the educational mission of academic faculty within a viable delivery system; (5) satisfaction of managed care providers with graduates of academic medical centers, as measured by the clinical skills of graduate physicians. The study findings showed little support among managed care plans for paying supplements to include faculty practices in a health care network. Most study participants from managed care systems and academic faculty practices identified limited competencies that are unique to academic centers. Moreover, managed care organizations were only willing to undertake limited restructuring at best to include faculty practices within their networks. General concern about the preparation of resident physicians (especially those in primary care disciplines) for practice within contemporary managed care organizations existed among managed care informants. The results of the study indicate that as traditional funding sources for medical education are reduced, schools require greater integration with managed care plans to enable academic medical centers and their faculties to continue promoting clinical enterprise.

Academic Medical Centers↗
PubMed1993

Potential public expenditures under managed competition.

This DataWatch estimates the public cost of providing universal coverage under a managed competition model. First, a uniform benefit package is specified; next, the lowest-cost premium for this coverage is estimated, based on average costs in a well-managed health maintenance organization (HMO). Based on these estimates, the cost of premium subsidies and tax revenue effects are determined. It is estimated that if coverage is extended to currently uninsured persons using these estimates and assumptions, spending for these persons will increase 73.9 percent over current levels. The authors estimate a net increase of $47.9 billion in 1993 health spending under a managed competition program with low patient cost sharing. This includes savings of $4.5 billion from wider use of managed care and $11.2 billion in administrative cost savings.

Competitive Medical Plans↗
PubMed2002

Managed competition and consumer price sensitivity in social health insurance.

This paper examines whether the introduction of managed competition in Dutch social health insurance has resulted in effective price competition among insurance funds. We find evidence of limited price competition, which may be caused by low consumer price sensitivity. Using aggregate panel data from all insurance funds over the period 1996-1998, estimated premium elasticities of market share are -0.3 for compulsory coverage and -0.8 for supplementary coverage. These elasticities are much smaller than in managed competition settings in US group insurance. This may be explained by differences in switching experience and higher search costs associated with individual insurance.

Actuarial Analysis↗
PubMedDate not supplied

Tuberculosis control and managed competition in Colombia.

Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals.

BCG Vaccine↗
PubMed2005

Exploring limits to market-based reform: managed competition and rehabilitation home care services in Ontario.

The rise of neo-liberalism, which suggests that only markets can deliver maximum economic efficiency, has been a driving force behind the trend towards using market-based solutions to correct health care problems. However, the broad application of market-based reforms has tended to assume the presence of fully functioning markets. When there are barriers to markets functioning effectively, such as the absence of adequate competition, recourse to market-based solutions can be expected to produce less than satisfactory, if not paradoxical results. One such case is rehabilitation homecare in Ontario, Canada. In 1996, a "managed competition" model was introduced as part of a province-wide reform of home care in an attempt to encourage high quality at competitive prices. However, in the case of rehabilitation home care services, significant obstacles to achieving effective competition existed. Notably, there were few private provider agencies to bid on contracts due to the low volume and specialized nature of services. There were also structural barriers such as the presence of unionized employees and obstacles to the entry of new providers. This paper evaluates the impact of Ontario's managed competition reform on community-based rehabilitation services. It draws on data obtained through 49 in-depth key informant interviews and a telephone survey of home care coordinating agencies and private rehabilitation provider agencies. Instead of reducing costs and improving quality, as the political rhetoric promised, the analysis suggests that providing rehabilitation homecare services under managed competition resulted in higher per-visit costs and reduced access to services. These findings support the contention that there are limits to market-based reforms.

Efficiency, Organizational↗
PubMed1995

Managed competition: issues for Australia.

Rising costs and slower economic growth are resulting in progressive stress on the current structure of health care finance in Australia. As in other developed countries, managed competition offers a potential solution, by increasing system efficiency. The case for restructuring current financing arrangements is even stronger than in other countries because of inefficiencies arising from inconsistencies and overlaps between Commonwealth, State and private sector functions. This paper outlines an illustrative model for managed competition in Australia. In addition, it discusses in more detail two specific issues which have received some attention in the literature: whether to have multiple payers, in the form of competing public and private budget holders; and whether 'catastrophic risks' such as long-term institutional care should be incorporated in a managed competition program.

Australia↗
PubMed1994

Managed competition for the poor: more promise than value?

President Clinton and many other elected officials have proposed that managed competition be the cornerstone of health care reform. However, experiences of Medicaid recipients with managed care plans are at best mixed. These capitated programs report higher costs than do fee-for-service arrangements. Fortunately, these additional expenditures are partially offset by at least a perception of improved access to care. Due to difficulties in determining eligibility, delivering benefits, paying for needed services, and similar concerns, providing care for the poor and underserved will be complicated and expensive for the proposed sponsors of managed competition plans.

Competitive Medical Plans↗
PubMedDate not supplied

The politics of managed competition: public abuse of the private interest.

The doctrine of managed competition in health care sought to achieve the social goals of access and efficiency using market incentives and consumer choice rather than governmental regulation and public administration. In retrospect, it demanded too much from both the public and the private sectors. Rather than develop choice-supporting rules and institutions, the public sector has promoted process regulation and benefit mandates. The private health insurance sector has pursued short-term profitability rather than cooperate in the development of fair competition and informed consumer choice. Purchasers have subsidized inefficient insurance designs in order to exploit tax and regulatory loopholes and to retain an image of corporate paternalism. America's health care system suffers from the public abuse of private interests and the private abuse of the public interest.

Consumer Behavior↗
PubMed2005

Levelling the playing field? Exploring the implications of managed competition for voluntary sector providers of long-term care in small town Ontario.

This paper considers how long-term care restructuring, under the rubric of managed competition, has increased pressure on voluntary sector providers of long-term care to elderly populations in small, rural places. Drawing on in-depth interviews with key-informants from non-profit organizations, we present a case study set in rural Ontario to develop a situated understanding of the impact of restructuring on voluntary sector providers of long-term care. We contend that managed competition (underway in Ontario since 1995) has constrained providers, eroded service choices, and reduced access to long-term care in rural areas leaving rural populations more disadvantaged than ever before when it comes to public service provisioning.

Humans↗
PubMed2006

Managing competition in the countryside: Non-profit and for-profit perceptions of long-term care in rural Ontario.

This paper contributes to the current debates surrounding private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit providers of long-term care in rural and small town settings. It focuses on the empirical case of Ontario, Canada where extensive restructuring of long-term care, under the rubric of managed competition, has been underway since the mid-1990s. In-depth interviews with 72 representatives from local governments, public health institutions and authorities, for-profit and non-profit organisations, and community groups during July 2003 to December 2003 form the platform for a qualitative analysis of the implications of managed competition as it relates to the provision of long-term care in the countryside. The results suggest that the introduction and implementation of managed competition has accentuated the problems of service provision in rural communities, and that the long-standing issues of caregiving in rural situations transcend the differences, perceived or otherwise, between for-profit and non-profit provision. Understanding the implications of market-oriented long-term care restructuring initiatives for providers, and their clients, in rural situations requires a re-focussing of research beyond the for- versus non-profit dichotomy.

Aged↗
PubMed1993

Managed competition set to restructure application portfolios.

The managed-competition reform plan favored by the Clinton administration is set to turn American healthcare delivery upside down. Information managers cannot afford to become nonchalant about the proposed changes. The imminent reforms will not be fads or trendy experiments. They will be fundamental and far-reaching.

Competitive Medical Plans↗