Biomedical subjects
Publications and source records attributed to W McClure.
The author argues that free market competition has not been given a fair chance in the health care industry and that the basic characteristics of a sound market can be met in the United States if the problem of asymmetric information is efficiently addressed. He proposes the "Buy-Right" system as an effective model for market reform.
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Capitation as an alternative to traditional charge and cost reimbursement has been a serious policy issue since at least 1970, and is currently one of the most seriously debated and far-reaching health issues before Congress. Nonetheless, the research effort on risk-adjusted per capita payment has been meager. In this overview, the author points out the pitfalls of prior utilization as a basis for capitation rates. He suggests instead that a capitation risk adjustment system be developed that eliminates cost variation resulting from patient risk but not that resulting from provider inefficiency, and that risk values across groups be normalized to prevent "risk group creep" and to ensure budget neutrality. He concludes that because obstacles were overcome in developing the current per admission DRG system for Medicare, the same can be done for a capitation system, and makes specific suggestions for doing so.
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This article reviews the so-called competition strategy for medical care. It sets out the policy goals of the strategy and the problems in the present medical and insurance system that it seeks to address. It then describes several distinct formulations of the competition strategy, showing that it is not a single, rigid, monolithic approach, but rather a flexible combination of market-oriented approaches. Finally, it briefly discusses the technical and political problems and prospects of the strategy.
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The population of Olmsted County, Minnesota, receives care virtually exclusively from two fee-for-service group practices: the Mayo Clinic and the Olmsted Medical and Surgical Group. Study of the use of acute-care hospital services by this population in 1976 reveals that the hospital discharge rate per 1,000 population, adjusted for age and sex, was 30% less than the national rate; the age-sex-adjusted rate of hospital days per 1,000 population was 38% less than the national rate. Analysis by length of stay, type of hospital service, frequency of selected diagnoses and surgical procedures, and certain demographic and economic characteristics did not explain the differences from national use rates. These rates are comparable, after age and sex adjustment, with those in larger prepaid group practices. The analysis suggests that the organization of medical care may have an important influence on hospital use.
This paper seeks to clarify so-called competition strategies for medical care, and to present a more flexible approach for public policy to encourage competition. In so doing, it appears useful to divide a competition strategy into two parts: (1)a structurally sound market mode for the future medical delivery and financing system, and (2) a strategy to implement the chosen model. Policymakers may choose any model that satisfies that structural conditions of a sound market. After listing there principal conditions, this paper presents two distant market models that satisfy them in entirely different ways and a third model that combines the first two. Once a specific market model is chosen, policymakers may choose among a variety of ways to implement it. Some implementation strategies require coercive legislation, others rely more on persuasive leadership, pressures, and incentives. The paper points out that all of these strategies must address certain common action areas: it then proposes one implementation strategy in some detail and uses it to illustrate a way to address each of these area. Although it certainly is not the only possible strategy, the proposal would appear to be practical approach for implementing effective competition.