Download or read book Health Care Utilization in Employer Plans with Preferred Provider Organization Options written by Susan D. Hosek and published by . This book was released on 1990 with total page 118 pages. Available in PDF, EPUB and Kindle. Book excerpt: Using data from five employers who were among the first to offer their employees preferred provider organization (PPO) options, this study estimates the PPOs' effects on participants' use of health care services in general and mental health care services in particular. The employers offered different incentives to use PPO providers: two waived all cost-sharing, one waived the deductible, one waived the coinsurance, and one cut the coinsurance for physician services in half. Unlike some other PPO plans, however, none covered additional services in the PPO. The research was based on data from personnel records, medical claims records, and an employee survey. Approximately two years after the PPO options were first offered, they had attracted 24-65 percent of the employees and covered dependents enrolled in indemnity plans. Among users, there was a consistent pattern of lower levels of use, as measured by total charges and reimbursements. Only three employee groups were large enough to warrant a separate analysis for mental health services. In the first post-PPO year, two of the three groups showed a lower propensity to use mental health services in the PPO, but the difference all but disappeared by the second year.
Download or read book Research Plan for the Preferred Provider Organization Study written by Paul B. Ginsburg and published by . This book was released on 1986 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Note outlines the research plan for RAND's Preferred Provider Organization (PPO) Study, which will analyze the experience of six large employers that have contracted with one or more PPOs to provide additional options for employees participating in the employers' health benefits plans. The research plan is designed to answer three broad questions: (1) What are the characteristics of employees who elect to enroll in the PPO plan, or use providers participating in the PPO? (2) What is the effect of PPOs on health services utilization and costs? (3) Do providers participating in PPOs practice differently from those declining to participate, or those not included in the PPO? The study will use econometric analysis, simulation, actuarial analysis, and case studies, and it will use four kinds of data: personnel records, surveys of employees, health insurance claims data, and a survey of physicians.
Download or read book Introducing the Preferred Provider Organization Option Into Health Benefit Plans written by Elizabeth S. Rolph and published by . This book was released on 1990 with total page 157 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Note describes preferred provider organization (PPO) arrangements of employers in three different locales. For each of these case studies, the Note describes the context in which the PPO arrangement was constituted and first marketed, including the existing health care marketplace, the program objectives of the various PPO participants, and their initial negotiating efforts. It also examines the features tailored to attract the participating subscribers, payers, and providers, giving specific attention to the channeling incentives offered to attract subscribers and guarantee volume to providers. It also examines the discounting practices adopted to meet the cost-containment objectives of the payers. Finally, it explores the utilization review procedures--a second cost-containment device--for each case study. The findings suggest that the original PPO concept's distinct outlines are now blurring, and that it may still be too early to describe the PPO's ultimate shape and function.
Download or read book The Effects of Preferred Provider Options on Use of Outpatient Mental Health Services for Three Employee Groups written by Kenneth B. Wells and published by RAND Corporation. This book was released on 1991 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Study of Preferred Provider Organizations written by Susan D. Hosek and published by . This book was released on 1990 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Consumer directed Health Plans written by Office, U.s. Government Accountability and published by . This book was released on 2017-08-16 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Consumer-directed health plans (CDHP) combine a high-deductible health plan with a tax-advantaged account, such as a health reimbursement arrangement (HRA), that enrollees can use to pay for health care expenses. In an effort to restrain cost growth, several employers, including the federal government through its Office of Personnel Management (OPM), have offered HRAs for several years.For enrollees in HRAs compared with those in traditional plans such as preferred provider organization (PPO) plans, GAO assessed (1) differences in health status, and (2) changes in spending and utilization of health care services. GAO analyzed data from two large employers-one public and one private-that introduced an HRA option in 2003. GAO compared changes in health spending and utilization before and after 2003 for enrollees who switched from a PPO into an HRA (the HRA group) with those who stayed in a PPO (the PPO group). At the time GAO made its data requests to each employer, 2007 data from the public employer and 2005 data from the private employer were the most current and complete data available. GAO also reviewed published studies that included an assessment of the health status, spending, or utilization of HRA and other CDHP enrollees compared..."
Download or read book Employment and Health Benefits written by Institute of Medicine and published by National Academies Press. This book was released on 1993-02-01 with total page 381 pages. Available in PDF, EPUB and Kindle. Book excerpt: The United States is unique among economically advanced nations in its reliance on employers to provide health benefits voluntarily for workers and their families. Although it is well known that this system fails to reach millions of these individuals as well as others who have no connection to the work place, the system has other weaknesses. It also has many advantages. Because most proposals for health care reform assume some continued role for employers, this book makes an important contribution by describing the strength and limitations of the current system of employment-based health benefits. It provides the data and analysis needed to understand the historical, social, and economic dynamics that have shaped present-day arrangements and outlines what might be done to overcome some of the access, value, and equity problems associated with current employer, insurer, and government policies and practices. Health insurance terminology is often perplexing, and this volume defines essential concepts clearly and carefully. Using an array of primary sources, it provides a store of information on who is covered for what services at what costs, on how programs vary by employer size and industry, and on what governments doâ€"and do not doâ€"to oversee employment-based health programs. A case study adapted from real organizations' experiences illustrates some of the practical challenges in designing, managing, and revising benefit programs. The sometimes unintended and unwanted consequences of employer practices for workers and health care providers are explored. Understanding the concepts of risk, biased risk selection, and risk segmentation is fundamental to sound health care reform. This volume thoroughly examines these key concepts and how they complicate efforts to achieve efficiency and equity in health coverage and health care. With health care reform at the forefront of public attention, this volume will be important to policymakers and regulators, employee benefit managers and other executives, trade associations, and decisionmakers in the health insurance industry, as well as analysts, researchers, and students of health policy.
Download or read book Participation and Satisfaction in Employer Plans with Preferred Provider Organization Options written by Susan D. Hosek and published by . This book was released on 1990 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Preferred provider organizations (PPOs) are growing rapidly in number and enrollment as an alternative to health maintenance organizations (HMOs) and traditional indemnity plans. Through their selective contracting and patient channeling mechanisms, PPOs may become an important competitive force in the health market. Their competitive impact will depend on whether they are successful in channeling a representative cross-section of patients to selected providers. Using data from five employers who offer their employees PPOs, this report investigates (1) levels of employee participation in the PPO option; (2) selection effects in the choice of health maintenance organization (HMO) vs. indemnity plans and, among those covered by an indemnity plan PPO vs. non-PPO options; and (3) satisfaction for PPO vs. non-PPO and HMO participants. The results suggest that PPOs can achieve significant patient channeling without experiencing strong adverse or favorable selection. If they can also contain costs, they should continue to grow and affect competition among health care providers.
Download or read book Law and Practice of Private Health Insurance and Managed Care written by Christian Funk and published by diplom.de. This book was released on 2000-04-28 with total page 147 pages. Available in PDF, EPUB and Kindle. Book excerpt: Inhaltsangabe:Abstract: A true revolution has taken place in the financing of health care in America. Today, managed care is dominating the way Americans receive and pay for their health care. With the rise of managed care medicine has been wrenched out of its atomized world of solo physician practices and community hospitals and has been transformed into a modern industry of giant for-profit companies traded on Wall Street. The current marketplace is characterized by mergers, acquisitions and the establishment of giant multi-billion dollar healthcare networks. Hospitals and managed care plans run big advertisement campaigns in the media, praising their products and services in order to get the biggest share possible of the $1.1 trillion America spends on health care each year. All parties involved in providing health care lobby for their interests at all levels of political decision-making in order to influence legislators and policymakers. Today s health care market changes quickly and at a high rate. New variations of managed care arise constantly making any analysis of managed care an ongoing game of "catch-up" with the marketplace. While writing this paper, for example, UnitedHealthcare dropped one of the major managed care instruments, utilization review, to address public s concerns and pending legislation. This paper will take a snapshot of managed care on the eve of the new millennium by using the most recent information available. After this introduction, the paper will give a description of the current American health care system in chapter two (The U.S. Health Care System). Then, the paper will focus on two aspects: A detailed description of managed care in chapter three (Managed Care) and an introduction of the main issues connected with this way of providing health care in chapter four (Managed Care issues). The paper will argue in chapter five (Results and Future Developments), that managed care of the future will be a light version of what is currently existing, resulting in less strict restrictions and more freedom for patients and doctors. Finally, the report will focus on recent developments in Germany, where policy-makers have started to adopt particular elements of managed care. In chapter six (Managed Care Approaches in Germany), the paper will argue, that Germany should pay more attention to the American experiences regarding managed care in order to prevent harm for patients in [...]
Download or read book Evaluating Preferred Providers written by and published by . This book was released on 1985 with total page 12 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Employer paid Health Insurance is Disappearing written by and published by . This book was released on 1989 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Employee Healthcare Benefits An Introduction to POPs FSAs HRAs and HSAs written by and published by America's Health Insurance Plans. This book was released on 2005 with total page 182 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Cost Management written by Robert D. Cooper and published by . This book was released on 1984 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Care Without Coverage written by Institute of Medicine and published by National Academies Press. This book was released on 2002-06-20 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Download or read book Participation and Satisfaction in Employer Plans with Preferred Provider Organization Options written by Susan D. Hosek and published by . This book was released on 1990 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt: Preferred provider organizations (PPOs) are growing rapidly in number and enrollment as an alternative to health maintenance organizations (HMOs) and traditional indemnity plans. Through their selective contracting and patient channeling mechanisms, PPOs may become an important competitive force in the health market. Their competitive impact will depend on whether they are successful in channeling a representative cross-section of patients to selected providers. Using data from five employers who offer their employees PPOs, this report investigates (1) levels of employee participation in the PPO option; (2) selection effects in the choice of health maintenance organization (HMO) vs. indemnity plans and, among those covered by an indemnity plan PPO vs. non-PPO options; and (3) satisfaction for PPO vs. non-PPO and HMO participants. The results suggest that PPOs can achieve significant patient channeling without experiencing strong adverse or favorable selection. If they can also contain costs, they should continue to grow and affect competition among health care providers.
Download or read book The PPO Handbook written by S. Brian Barger and published by Aspen Publishers. This book was released on 1985 with total page 224 pages. Available in PDF, EPUB and Kindle. Book excerpt:
