MANAGED CARE AND HEALTH CARE MARKETS

这个项目解决了管理型医疗保健增长引发的对医疗保健质量的担忧。它建议通过开发该国最大和最先进的管理保健措施集合来实现这一点，然后将这些措施用于两个重要应用。因此，该项目包括三个部分：(1)通过汇编新措施和应用新技术来构建更精确的管理保健衡量标准，改进对市场管理保健活动的衡量；(2)研究管理保健增长对保健市场表现的影响，包括对患者护理的具体措施和结果的研究；(3)评估管理保健增长的立法和监管决定因素的影响。该项目将推进管理医疗的衡量状况，并将提供关于管理医疗对医疗保健市场的影响以及特定政策对管理医疗的影响的具体、定量的证据。这样做将有助于政策制定者、公共和私人购买者、管理者和其他医疗保健领导者评估管理型医疗保健政策选择。我们的目标包括：1。汇编和评估一系列管理保健活动的衡量标准。这些数据将包括关于各种计划类型的普及率和市场份额的数据，关于计划的具体成本降低活动的数据，如对提供商选择、资本充足率和使用管理的限制，以及关于计划之间竞争的数据。2.综合现有措施，制定新的、更精确的卫生保健组织活动具体衡量标准，以及更广泛的管理护理活动衡量标准。我们将特别专注于制定长期有效的措施。3.研究管理保健的增长和健康计划之间的竞争对患者的治疗、成本和健康结果的影响，包括那些参加管理保健计划的患者和那些未参加管理保健计划的患者。4.研究决定管理型医疗保健增长的因素，特别是管理型医疗保健法规，包括任何自愿提供者法、选择自由法、强制福利、申诉程序法、扩大患者起诉管理型医疗保健计划的权利的责任法，以及医疗必要性定义。

This project addresses concerns about quality of health care prompted by the growth of managed care. It proposes to do so by developing the largest and most advanced collection of managed care measures in the country and then by using these measures in two important applications. The project thus has three parts: (1) improving the measurement of managed care activity in markets by compiling new measures and applying new techniques to construct more precise measures of managed care, (2) examining the impact of the growth of managed care on the performance of health care markets, including study of specific measures of care for patients and outcomes, and (3) assessing the impact of legislative and regulatory determinants of managed care growth. The project will advance the state of managed care measurement and will produce specific, quantitative evidence about the effects of managed care on health care markets and about the effects of specific policies on managed care. Doing so will help policy-makers, public and private purchasers, managers, and other health care leaders to assess managed care policy options. Our aims include: 1. To compile and evaluate a wide range of measures of managed care activity. These will include data on the prevalence and market share of various plan types, data on the specific cost-reducing activities of plans like restrictions on provider choice, capitation, and utilization management, and data on competition between plans. 2. To synthesize existing measures to develop new, more precise, measures of HMO activity specifically, and managed care activity more broadly. We will specifically focus on developing measures that are valid over time. 3. To examine the effects of growth in managed care and competition among health plans on treatments, costs, and health outcomes for patients, including both those enrolled in managed care plans and those not enrolled. 4. To study the factors that determine the growth of managed care, particularly managed care regulations, including any willing provider laws, freedom of choice laws, mandated benefits, grievance procedure laws, liability laws that expand the rights of patients to sue managed care plans, and medical necessity definitions.