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Managed care plan performance since 1980. A literature analysis

R H Miller1, H S Luft

  • 1University of California-San Francisco, Institute for Health & Aging 94143.

JAMA
|May 18, 1994
PubMed
Summary
This summary is machine-generated.

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Managed care plans, such as health maintenance organizations (HMOs), show lower hospital use and higher use of preventive services than indemnity plans. However, enrollee satisfaction with services is lower, though satisfaction with costs is higher.

Area of Science:

  • Health Services Research
  • Comparative Effectiveness Research
  • Health Economics

Background:

  • Managed care plans have evolved significantly since 1980.
  • Indemnity plans represent a traditional approach to health insurance.
  • Understanding differences in plan performance is crucial for policymakers and consumers.

Purpose of the Study:

  • To compare health care utilization, expenditure, quality of care, and enrollee satisfaction between managed care and indemnity plans.
  • To synthesize evidence on the performance of different managed care models.

Main Methods:

  • Systematic literature review of studies from 1980 onwards.
  • Inclusion of private insurance and Medicare enrollees with comparison groups.
  • Focus on peer-reviewed studies with statistical adjustments for enrollee characteristics.

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Main Results:

  • Health maintenance organizations (HMOs) exhibit lower hospital admission rates and shorter lengths of stay compared to indemnity plans.
  • HMOs demonstrate increased use of preventive services and decreased use of expensive procedures.
  • Enrollee satisfaction with services was lower in HMOs, but satisfaction with costs was higher.

Conclusions:

  • Managed care plans demonstrate distinct utilization patterns compared to indemnity plans.
  • Evidence does not strongly support the superiority of specific managed care organizational structures (e.g., staff model vs. IPA model).
  • Generalizations require caution due to unmeasured selection bias, evolving plan structures, and market dynamics.