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Title
Alternative geographic configurations for Medicare payments to health maintenance organizations.
First Author
Porell, Frank W
Date of Pub
1990 Spring
Pages
17-30
Volume
11
Issue
3
Other Authors
Tompkins, Christopher P; Turner, Winston M
Abstract
Under prevailing legislation, Medicare payments to health maintenance organizations (HMOs) are based upon projected fee-for-service reimbursement levels for enrollees' county of residence. These rates have been criticized in light of substantial variations in rates among neighboring counties and large fluctuations in rates over time. In this study, the use of nine alternative configurations and the county itself were evaluated on the basis of payment-area homogeneity, payment rate stability, and policy criteria, including the fiscal impacts of reconfiguration on HMOs. The results revealed rather modest differences among most alternative configurations and do not lend strong support for payment area reconfiguration at this time.
Abstract Continued
N/A
MeSH
Analysis of Variance : Catchment Area (Health)/economics : Data Collection : Evaluation Studies : Health Maintenance Organizations/economics : Medicare/organization & administration : Models, Theoretical : Rate Setting and Review/methods : Reimbursement Mechanisms/organization & administration : Research Design : Support, U.S. Gov't, Non-P.H.S. : United States
NTIS Number
PB90-258153