- Title
- Out-of-plan use by Medicare enrollees in a risk-sharing health maintenance organization.
- First Author
- Haglund, Claudia L
- Date of Pub
- 1985 Winter
- Pages
- 39-49
- Volume
- 7
- Issue
- 2
- Other Authors
- Diehr, Paula; Johnston, Ric; Martin, Diane P; Richardson, William C
- Abstract
- In this study, we analyzed the cost and volume effects of a waiver that eliminated lock-in restrictions on out-of-plan use in a health maintenance organization (HMO) with a Medicare risk-sharing contract. We compared out-of-plan cost and number of claims during a 15-month base line period when the lock-in was in effect, with a 24-month waiver period when the lock-in was removed. The results demonstrate that average per capita cost and claims increased significantly for both Medicare Part A (hospital insurance) and Part B (supplementary medical insurance) out-of-plan services during the waiver. Self-referred out-of-plan use normally prohibited by lock-in, accounted for 20 percent of all out-of-plan costs during the waiver and 57 percent of the increase in out-of-plan costs from the lock-in to the waiver. The combination of risk-sharing and lock-in provisions holds promise as a method for reducing expenditures for the Medicare program.
- Abstract Continued
- N/A
- MeSH
- Health Maintenance Organizations : Costs and Cost Analysis : Emergencies : Health Services/utilization : Medicare/utilization : Pilot Projects : Statistics : Support, U.S. Gov't, Non-P.H.S. : Washington
- NTIS Number
- PB86-198900
