How does managed care do it?

D M Cutler; M McClellan; J P Newhouse

Home/Archive/PubMed

PubMed · 11503704

How does managed care do it?

D M Cutler·M McClellan·J P Newhouse

View original source ↗Export metadata ↓

Abstract

Integrating the health services and insurance industries, as health maintenance organizations (HMOs) do, could lower expenditure by reducing either the quantity of services or unit price or both. We compare the treatment of heart disease in HMOs and traditional insurance plans using two datasets from Massachusetts. The nature of these health problems should minimize selection. HMOs have 30% to 40% lower expenditures than traditional plans. Both actual treatments and health outcomes differ little; virtually all the difference in spending comes from lower unit prices. Managed care may yield substantial increases in measured productivity relative to traditional insurance.

Explore related subjects

Data Collection Delivery of Health Care Health Expenditures Heart Diseases Humans Insurance, Health Insurance, Health, Reimbursement Managed Care Programs Massachusetts Models, Statistical Quality Assurance, Health Care United States Journal Article

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

D M Cutler, M McClellan, J P Newhouse. 2000. How does managed care do it?. https://pubmed.ncbi.nlm.nih.gov/11503704/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2003

Following Shipman: a pilot system for monitoring mortality rates in primary care.

As part of the investigations into the crimes of Harold Shipman, it has become clear that there is little monitoring of deaths in general practice. By use of data on annual deaths at family physician and practice level for five English health authorities for 1993-99, we investigate whether cumulative sum charts (a type of statistical process control chart) could be used to create a workable monitoring system. On such charts, thresholds for deaths can be set, which, if crossed, may indicate a potential problem. We chose thresholds based on empirical calculations of the probabilities of false and successful detection after allowing for multiple testing over physicians or practices. We also statistically adjusted the charts for extra-Poisson variation due to unmeasured case mix. Of 1009 family physicians, 33 (including Shipman) crossed the alarm threshold designed to detect a 2 SD increase in standardised mortality, with 97% successful detection and a 5% false-alarm rate. Poor data quality, plus factors such as the proportion of patients treated by these physicians in nursing homes or hospices are likely explanations for most of these additional alarms. If used appropriately, such charts represent a useful tool for monitoring deaths in primary care. However, improvement in data quality is essential.

Data Collection↗

PubMed2003

Soft data, hard effects. Strategies for effective policy on health impact assessment--an example from the Netherlands.

Health impact assessment (HIA) on a strategic level focuses on the broad determinants of health. However, the evidence with regard to the health impacts is often necessarily 'soft'. The example of a health impact review on national housing policy in the Netherlands shows that HIA can be effective even in the absence of hard data. Strategies used to overcome the problem of not having hard data are outlined. The authors argue that, for HIA to be effective, it does not necessarily have to be limited to easy-to-measure, easy-to-quantify programmes and health effects.

Data Collection↗

PubMed2003

Evaluation as a key part of health impact assessment: the English experience.

Health impact assessment (HIA) is an approach that has experienced increased activity and wide support within England. This is reflected in the large number of HIAs being undertaken at local and regional levels, by the advocacy of HIA in many national policy documents, and by the setting up of specialized HIA posts and centres. To continue this level of support, and to justify any increase, the approach of HIA must show whether and how the HIA approach informs the decision-making process and, in particular, whether it improves health and reduces health inequalities. The first steps in answering these questions have been taken by the partial evaluation of some completed HIAs within England. A description of these evaluations is presented. Work is also progressing on promising practice guidance for practitioners on the topic of evaluating HIAs. The further development of evaluation within HIA is required, at both a practitioner and research level, and provides an exciting opportunity for people and groups to advance the evidence base for HIA, while also proving its place as an effective public health intervention.

Data Collection↗