COMPETITION, COSTS & ACCESS IN THE CHANGING HMO INDUSTRY

营利性和系统附属医疗保健设施的增长 人们普遍预计将对交付 医疗服务。对这些问题的影响的大部分研究 正在进行的机构改革一直基于 在相对缺乏竞争的环境中运营的设施 基于成本的报销。因此，它可能不适用于健康 竞争和预期付费正在成为一种护理体系 变得越来越重要。 为了更好地了解这些制度变化的影响，我们建议 研究系统和所有权的增长对 医疗保健组织。HMO行业似乎是一个有用的试验场，原因有几个。 首先，营利性计划和系统附属计划的数量有所增加 近几年来迅速增长。其次，因为HMO是预付的，而且 在日益激烈的竞争中，这些因素的影响 体制因素将更像那些将在 未来的医疗保健系统。最后，医疗保健组织的增长在一定程度上是因为 旨在促进计划和计划之间竞争的联邦政策的结果 使私人保险和医疗保险双方更容易获得预付费医疗服务 参加联邦医疗保险和医疗补助的人。然而，有可能这些 正在进行的制度变革将给这些政策目标设置障碍。 这里提出的研究有两个基本目标：第一，评估 HMOS的系统控制和投资者所有权对交付的影响 在成本和访问方面的服务；第二，找出 哪些不断变化的机构特征可能会影响到自然和 医疗保健组织之间的竞争程度。要进行这些评估，请使用 纵向数据库将从现有的二级数据和 将纳入1980至1986年间运营的所有医疗保健组织的信息， 以及关于卫生保健组织所在社区特征的数据 找到了。

The growth of for-profit and system-affiliated health care facilities is widely anticipated to have important consequences for the delivery of health services. Much of the research into the implications of these ongoing institutional changes has been based on the performance of facilities operating in a relatively uncompetitive environment under cost-based reimbursement. It may therefore not be applicable to a health care system in which competition and prospective payment are becoming increasingly important. To better understand the impact of these institutional changes, we propose to study the effects of the growth of systems and proprietary ownership on HMOs. The HMO industry seems a useful testing ground for several reasons. First, the number of for-profit and system-affiliated plans has grown rapidly in recent years. Second, because HMOs are pre-paid and increasingly in active competition with one another, the effects of these institutional factors will be more like those which will be common in the health care system in the future. Finally, HMOs have grown in part as the result of federal policies intended to promote competition among plans and to make pre-paid care more accessible to both the privately insured and enrollees in Medicare and Medicaid. It is possible, however, that these ongoing institutional changes will create barriers to these policy goals. The study proposed here has two basic objectives: first, to assess the effects of system control and investor ownership in HMOs on delivery of services in terms of costs and access and second, to identify the ways in which changing institutional characteristics may affect the nature and extent of competition among HMOs. To make these assessments, a longitudinal data base will be constructed from existing secondary data and will incorporate information on all HMOs operating between 1980 and 1986, as well as data on the characteristics of the community in which the HMO is located.