Do health maintenance organizations work for Medicare?
Brown, Randall S
Date of Pub
Bergeron, Jeanette W; Clement, Delores G; Hill, Jerrold W; Retchin, Sheldon M
Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide
Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves
some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service
(FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater
coverage. However, because the capitation system does not account for the better health of those who enroll, the program does
not save money for Medicare.
Capitation Fee : Comparative Study : Consumer Satisfaction : Cost Savings/methods : Data Collection : Health Maintenance Organizations/economics/statistics
& numerical data/utilization : Hospitals/utilization : Medicare/organization & administration : Program Evaluation/economics/statistics
& numerical data : Risk : Support, U.S. Gov't, Non-P.H.S. : Treatment Outcome : United States : United States Health Care