TY - JOUR
T1 - Health maintenance organizations
T2 - The beginning or the end?
AU - Feldman, R.
AU - Kralewski, J.
AU - Dowed, B.
N1 - Copyright:
Copyright 2004 Elsevier B.V., All rights reserved.
PY - 1989
Y1 - 1989
N2 - This article describes the changes taking place in a mature HMO market that has been identified as a bellwhether HMO community, the Minneapolis-St. Paul metropolitan area. We describe how this market - previously characterized by traditional HMOs and traditional fee-for-service plans - has been transformed within the past five years into a market with a variety of plans competing on the dimensions of premiums, provider choice, and coverage. Among the most significant changes are the evolution of the local Blue Cross and Blue Shield plan into a form resembling an individual practice arrangement (IPA) with broad coverage and broad provider choice, and the appearance of preferred provider plans sponsored by the HMOs. We suggest that such changes have blurred the distinction between health plan types, making traditional plan designations no longer valid for either health policy analysis or health services research. For example, studies contrasting the performance of HMOs and fee-for-service plans should concentrate instead on the various dimensions of these plans, such as coverage and openness of provider choice. The article is intended to stimulate discussion and to suggest a new framework for describing health plan competition.
AB - This article describes the changes taking place in a mature HMO market that has been identified as a bellwhether HMO community, the Minneapolis-St. Paul metropolitan area. We describe how this market - previously characterized by traditional HMOs and traditional fee-for-service plans - has been transformed within the past five years into a market with a variety of plans competing on the dimensions of premiums, provider choice, and coverage. Among the most significant changes are the evolution of the local Blue Cross and Blue Shield plan into a form resembling an individual practice arrangement (IPA) with broad coverage and broad provider choice, and the appearance of preferred provider plans sponsored by the HMOs. We suggest that such changes have blurred the distinction between health plan types, making traditional plan designations no longer valid for either health policy analysis or health services research. For example, studies contrasting the performance of HMOs and fee-for-service plans should concentrate instead on the various dimensions of these plans, such as coverage and openness of provider choice. The article is intended to stimulate discussion and to suggest a new framework for describing health plan competition.
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M3 - Article
C2 - 2732057
AN - SCOPUS:0024366720
SN - 0017-9124
VL - 24
SP - 191
EP - 211
JO - Health services research
JF - Health services research
IS - 2
ER -