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Managed care: where do we go from here?

R Cauchi

    State Legislatures
    |November 26, 1999
    PubMed
    Summary
    This summary is machine-generated.

    Managed care enrollment, including Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), was substantial in 1997. Despite a premium decrease in 1997, HMO premiums are projected to rise.

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    Area of Science:

    • Health Services Research
    • Healthcare Management
    • Health Economics

    Background:

    • Managed care, encompassing Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), represents a significant segment of the U.S. healthcare system.
    • In 1997, 83.7 million individuals were enrolled in HMOs and 89.1 million in PPOs.
    • Insurance companies held ownership of 60.4% of PPOs, while 15 of the top 25 HMOs were nonprofit entities.

    Purpose of the Study:

    • To provide a statistical overview of the managed care landscape in the United States for the year 1997.
    • To detail enrollment figures, organizational structures, and market penetration within HMOs and PPOs.
    • To analyze trends in Health Maintenance Organization (HMO) premiums.

    Main Methods:

    • Data compilation from various sources on healthcare enrollment and organizational statistics for 1997.

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  • Analysis of ownership structures for Preferred Provider Organizations (PPOs).
  • Examination of Health Maintenance Organization (HMO) premium data, including historical and projected figures.

    • Main Results:

    • In 1997, 757 licensed HMOs and 1,035 PPOs operated in the U.S.
    • Managed care covered 46.7% of the Medicaid population (14.6 million) and 14.9% of the Medicare population (5.6 million).
    • Health Maintenance Organization (HMO) average monthly premiums decreased by 1.3% in 1997, but were projected to increase to $460 by 1999.

    Conclusions:

    • Managed care organizations (MCOs) demonstrated significant reach across the general, Medicaid, and Medicare populations in 1997.
    • The market structure of PPOs shows a strong influence of insurance company ownership.
    • While HMO premiums experienced a slight dip, an upward trend was anticipated, impacting healthcare costs for enrollees.