HMO penetration and the cost of health care: market discipline or market segmentation?
HMO penetration and the cost of health care: market discipline or market segmentation?
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HMO 渗透率和医疗保健成本：市场纪律还是市场细分？
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
Kenneth S. Corts
中科院分区：
文献类型：
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作者：
Laurence C. Baker;Kenneth S. Corts
最近的许多医疗保健改革提案都试图通过将服务的提供转向 HMO 等管理式医疗组织来减少医疗保健支出。 HMO 的支持者经常强调他们有能力通过监督医生的决策或实施按人头付费计划来控制成本，从而使医生的激励措施与医疗保健计划的激励措施保持一致。事实上，现有证据表明，与传统医疗保健提供者相比，HMO 确实具有较低的住院率和较短的住院时间，并且使用的昂贵测试和程序也较少（例如参见 R. H. Miller 和 H. S. Luft，1994 年）。一些支持者还认为，管理式医疗的日益突出会产生积极的外部性，使参加非 HMO 健康计划的消费者受益。这种论点通常会引用一些市场纪律的概念，认为传统保险公司或医疗保健提供者将不得不降低保费，才能在因管理式医疗计划的存在而变得“更具竞争力”的健康保险市场中保持活力。从这些
Many recent health-care reform proposals seek to reduce health-care expenditures by shifting the delivery of services toward managed-care organizations like HMO's. Proponents of HMO's often emphasize their ability to contain costs through oversight of physicians' decisions or by implementation of a capitated payment scheme that aligns physicians' incentives with those of the healthcare plan. Indeed, existing evidence suggests that HMO's do have lower hospitalization rates and shorter hospital stays and also use fewer expensive tests and procedures than traditional health-care providers (see e.g., R. H. Miller and H. S. Luft, 1994). Some proponents also argue that the increasing prominence of managed care generates positive externalities that benefit consumers enrolled in non-HMO health plans. This argument typically invokes some notion of market discipline, arguing that traditional insurers or health-care providers will have to lower premiums to remain viable in a health insurance market made "more competitive" by the presence of managed-care plans. From these