Individual-based risk adjustment by health insurers: needs, options, and methods.
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Actuarial Analysis↗
Biomedical subjects
J A Hester
Publications and source records attributed to J A Hester.
Real life lessons from a PPO plan.
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California↗
Evaluation of a preferred provider organization.
Preferred provider organizations (PPOs) have emerged as a new approach to organizing health care services; the promise of melding the primary strengths of indemnity insurance with HMO plans was rapidly embraced. The performance of PPOs has not yet been measured critically, despite their growth to over 250 plans. A single, large case study of PPO design and performance is examined, revealing a mixed but hopeful picture of administrative challenges, physician response, patient use patterns, and cost reductions, PPOs offer fertile ground for future research.
Adolescent↗
Research in resource allocation in a prepaid group practice.
Much that has been written about the concept, operation, and performance of HMOs--their use of resources compared with other health service systems--masks the real differences among HMOs themselves. Investigation of autonomous units within a unified HMO program shows a surprising diversity. Analytic formulations drawn from long-term and large-scale research fail to account for variations in staffing, budgeting, rate setting, and expansion when applied to institutional research. Judgment of intangibles remains a key aspect of most major decisions.
Ambulatory Care↗