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Evaluation of a preferred provider organization
J A Hester1, A Wouters, N Wright
1Pilgrim Health Care, Norwell, Mass.
The Milbank Quarterly
|January 1, 1987
Summary
Preferred provider organizations (PPOs) blend indemnity insurance and HMOs. This study examines PPO performance, finding administrative challenges but hopeful signs in physician response, patient use, and cost reduction.
Area of Science:
- Health Services Research
- Healthcare Management
- Health Insurance Models
Background:
- Preferred Provider Organizations (PPOs) represent an innovative healthcare organization model.
- PPOs aim to combine the strengths of traditional indemnity insurance and Health Maintenance Organization (HMO) plans.
- The rapid growth of PPOs to over 250 plans necessitates critical performance evaluation.
Purpose of the Study:
- To critically assess the performance of Preferred Provider Organizations (PPOs).
- To examine the design and operational outcomes of a large-scale PPO case study.
- To identify key challenges and successes in PPO implementation.
Main Methods:
- A single, large-scale case study approach was employed.
- Analysis focused on PPO design elements and performance metrics.
- Data collection likely involved administrative records, physician surveys, and patient utilization data.
Main Results:
- The study reveals a mixed performance picture for PPOs.
- Significant administrative challenges were identified.
- Hopeful indicators include positive physician response, evolving patient use patterns, and evidence of cost reductions.
Conclusions:
- PPOs present a complex but promising model for healthcare organization.
- Further research is warranted to optimize PPO design and performance.
- PPOs offer potential for improved healthcare delivery and cost-effectiveness.