MANAGED CARE AND HEALTH CARE MARKETS

该项目解决了由于管理式医疗的增长而引起的保健质量问题。它建议通过在国内开发最大和最先进的管理医疗措施集合，然后在两个重要应用中使用这些措施来实现这一目标。因此，该项目有三个部分：(1)通过编制新措施和应用新技术来构建更精确的管理式医疗措施，改进市场中管理式医疗活动的衡量标准；(2)检查管理式医疗增长对医疗保健市场绩效的影响，包括对患者护理和结果的具体措施的研究；(3)评估管理式医疗增长的立法和监管决定因素的影响。该项目将推进管理式医疗的现状测量，并将提供具体的定量证据，证明管理式医疗对医疗保健市场的影响以及具体政策对管理式医疗的影响。这样做将有助于决策者、公共和私人购买者、管理人员和其他卫生保健领导者评估管理式医疗政策选择。我们的目标包括：1；编制和评估管理式护理活动的各种措施。这些数据将包括关于各种计划类型的流行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，如对供应商选择的限制，资本化和利用管理，以及关于计划之间竞争的数据。2. 综合现有的措施，开发新的，更精确的，HMO活动的具体措施，更广泛的管理护理活动。我们将特别注重制定长期有效的措施。3. 检查管理式医疗的增长和健康计划之间的竞争对患者治疗、成本和健康结果的影响，包括参加管理式医疗计划和未参加管理式医疗计划的患者。4. 研究决定管理式医疗增长的因素，特别是管理式医疗法规，包括任何自愿提供者法、选择自由法、强制福利、申诉程序法、扩大患者起诉管理式医疗计划权利的责任法，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.