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Biomedical subjects

A C Enthoven

Publications and source records attributed to A C Enthoven.

At least 19 recordsLinked to original sources
PubMed1998

Total hip replacement: a case history.

The history of total hip replacement in the U.S. demonstrates that health care providers can reduce costs while improving quality. Nationwide, the cost of total hip replacements has declined dramatically while quality has improved. This article describes 14 clinical and management innovations ranging from patient education to competitive bidding.

Arthroplasty, Replacement, Hip↗
PubMed1996

Managed competition and California's health care economy.

There is evidence in California of a broad decline in health care costs to employment groups adopting managed care and managed competition--premium reductions up to 10 percent. National comparisons and utilization data generally confirm the beginning of lower costs. Large California medical groups and health systems have responded to pressure by finding ways to reduce costs and improve quality. While examples are encouraging, there is room for improvement. Two levels of competition have emerged and continue to evolve: carrier competition and delivery system competition. Each model has strengths and limitations, but the existing mix is driving down costs.

California↗
PubMed1995

'Responsible choices': the Jackson Hole Group plan for health reform.

"Responsible Choices" identifies the actions that the private sector and government should take to improve the U.S. health care system and accelerate and expand the health care revolution that is already underway. Policy proposals are made for Medicare; Medicaid; reforming the tax treatment of health insurance; insurance reforms and expanding group purchasing opportunities; and improving the availability of comparative information on health benefit offerings, quality accountability, and cost and coverage data. The recommendations refocus the Jackson Hole Group's original managed competition proposals contained in The 21st Century American Health System (1991).

Health Care Reform↗
PubMed1994

On the ideal market structure for third-party purchasing of health care.

The ideal market structure would give each medical care organization effective incentives to produce maximum value for money for enrolled subscribers. It should be based on integrated financing and delivery systems--partnerships that link doctors, hospitals and insurers--with per capita prepayment, with providers at risk for cost of care and cost of poor quality, publicly accountable for quality and per capita costs. The ideal market structure must be managed by active intelligent collective purchasing agents, called sponsors, that contract with health care systems and set the rules of competition. Sponsors structure and manage the enrollment process; they create price-elastic demand; they manage risk selection; and they create and administer equitable rules of coverage. Microeconomic theory tells us what sponsors should do to get the market incentives right. There is no comparable political theory to tell us how their boards of directors should be constituted. The paper offers a list of undesirable political arrangements to be avoided and some desirable features of sponsor constitutions.

Delivery of Health Care↗
PubMed1994

A single-payer system in Jackson Hole clothing.

President Clinton's Health Security Act relies on government regulation, not market forces, to control costs. The act creates an entitlement to comprehensive benefits and places the federal budget at risk for total health care costs in order to achieve universal coverage; it creates a system of new state purchasing monopsonies; and it attempts to control costs with price controls on health plan premiums, set and administered by a National Health Board that would be part of the executive branch, not insulated from political considerations. We believe there is a better way.

Cost Control↗
PubMed1994

Choosing among health plans.

The health care reform system that is ultimately adopted, suggest the authors of this analysis, should rely on market forces, rather than government regulation, to reduce cost and improve quality in our health care delivery. A major portion of this paper compares the Health Security act (the Clinton proposal), the American Health Security Act (the McDermott bill), the Health Equity and Access Reform Today, HEART (the Chafee proposal), and the Managed Competition Act (the Cooper bill). The article focuses on the major areas of difference between these alternative proposals in the extent to which they would achieve true market-based reform, small group reform, universal coverage, and financing mechanisms.

Evaluation Studies as Topic↗
PubMed1993

Why managed care has failed to contain health costs.

Much evidence points to the fact that managed care plans (health maintenance organizations and preferred provider insurance) reduce costs and offer value for money. Yet they apparently have not helped to slow national health expenditures. One explanation is that the practices of purchasers (including government and employers), the tax laws, and other market imperfections have reduced the demand for real cost containment, depriving managed care plans of an adequate incentive to cut cost and price. These market conditions can and should be corrected; the managed competition proposal being discussed at the national level is a comprehensive plan for doing so.

Competitive Medical Plans↗
PubMed1993

The history and principles of managed competition.

Managed competition in health care is an idea that has evolved over two decades of research and refinement. It is defined as a purchasing strategy to obtain maximum value for consumers and employers, using rules for competition derived from microeconomic principles. A sponsor (either an employer, a governmental entity, or a purchasing cooperative), acting on behalf of a large group of subscribers, structures and adjusts the market to overcome attempts by insurers to avoid price competition. The sponsor establishes rules of equity, selects participating plans, manages the enrollment process, creates price-elastic demand, and manages risk selection. Managed competition is based on comprehensive care organizations that integrate financing and delivery. Prospects for its success are based on the success and potential of a number of high-quality, cost-effective, organized systems of care already in existence, especially prepaid group practices. As it is outlined here, managed competition as a means to reform the U.S. health care system is compatible with Americans' preferences for pluralism, individual choice and responsibility, and universal coverage.

Competitive Medical Plans↗
PubMed1993

VIP interview: Alain C. Enthoven, Ph.D.

Alain C. Enthoven, Ph.D., is the Mariner S. Eccles Professor of Public and Private Management in the Graduate School of Business at Stanford University. He hold degrees in Economics from Stanford University, Oxford University (where he was a Rhodes scholar), and the Massachusetts Institute of Technology. Professor Enthoven has been an articulate advocate for restructuring the health care system. His far-reaching proposals on "consumer choice health plans" and "managed competition" in the 1930s established an intellectual framework for much of the current debate on national health policy. As a leader of the Jackson Hole Group, he favors internal market reform and employer tax incentives as the most effective means to control unnecessary medical costs.

Competitive Medical Plans↗