Does managed care lead to better or worse quality of care? A survey of recent studies shows mixed results on managed care plan performance.

被引:275
作者
Miller, RH
Luft, HS
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D O I
10.1377/hlthaff.16.5.7
中图分类号
R19 [保健组织与事业(卫生事业管理)];
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摘要
We analyzed evidence on managed care plan (mostly health maintenance organization, or HMO) performance from thirty-seven recently published peer-reviewed studies. Quality-of-care evidence from fifteen studies showed an equal number of significantly better and worse HMO results, compared with non-HMO plans. However, in several instances, Medicare HMO enrollees with chronic conditions showed worse quality of care. Evidence comparing hospital and physician resource use showed no clear pattern, whereas evidence on enrollee satisfaction varied by measure and enrollee type. Although recent research provides useful findings, interpreting and generalizing from these relatively few studies is difficult, Fears that HMOs uniformly lead to worse quality of care are not supported by the evidence, although all quality data were collected prior to the recent round of cost cutting that started in 1992. Hopes that HMOs would improve overall quality also are not supported, in part because of slow clinical practice change, lack of risk-adjusted capitation rates, and inadequate quality measurement and reporting.
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页码:7 / 25
页数:19
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共 44 条
[1]  
Adler G S, 1995, Health Care Financ Rev, V16, P175
[2]   The effect of managed care on ICU length of stay - Implications for Medicare [J].
Angus, DC ;
LindeZwirble, WT ;
Sirio, CA ;
Rotondi, AJ ;
Chelluri, L ;
Newbold, RC ;
Lave, JR ;
Pinsky, MR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (13) :1075-1082
[3]   INSURANCE-RELATED DIFFERENCES IN THE RISK OF RUPTURED APPENDIX [J].
BRAVEMAN, P ;
SCHAAF, VM ;
EGERTER, S ;
BENNETT, T ;
SCHECTER, W .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (07) :444-449
[4]   Medicaid Health Maintenance Organizations - Can they reduce program spending? [J].
Buchanan, JL ;
Leibowitz, A ;
Keesey, J .
MEDICAL CARE, 1996, 34 (03) :249-263
[5]   THE OUTCOMES AND COSTS OF CARE FOR ACUTE LOW-BACK-PAIN AMONG PATIENTS SEEN BY PRIMARY-CARE PRACTITIONERS, CHIROPRACTORS, AND ORTHOPEDIC SURGEONS [J].
CAREY, TS ;
GARRETT, J ;
JACKMAN, A ;
MCLAUGHLIN, C ;
FRYER, J ;
SMUCKER, DR ;
CURTIS, P ;
DARTER, J ;
DEFRIESE, G ;
EVANS, A ;
HADLER, N ;
HUNTER, G ;
JOINES, J ;
KALSBEEK, W ;
KONRAD, T ;
MCNUTT, R ;
RICKETTS, T ;
TAYLOR, D .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (14) :913-917
[6]  
CHERNEW M, 1995, INQUIRY-J HEALTH CAR, V32, P143
[7]   ACCESS AND OUTCOMES OF ELDERLY PATIENTS ENROLLED IN MANAGED CARE [J].
CLEMENT, DG ;
RETCHIN, SM ;
BROWN, RS ;
STEGALL, MBH .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1994, 271 (19) :1487-1492
[8]  
COLE RE, 1994, HOSP COMMUNITY PSYCH, V45, P1090
[9]   CHOICE MATTERS - ENROLLEES VIEWS OF THEIR HEALTH PLANS [J].
DAVIS, K ;
COLLINS, KS ;
SCHOEN, C ;
MORRIS, C .
HEALTH AFFAIRS, 1995, 14 (02) :99-112
[10]  
ETHEREDGE LM, 1995, RW JOHNS FDN INV M N