MANAGED CARE AND HEALTH CARE MARKETS

该项目旨在解决由于管理式保健的增长而引起的对保健质量的关注。 它建议通过在该国建立最大和最先进的管理式护理措施集，然后在两个重要应用中使用这些措施来做到这一点。 因此，该项目有三个部分：（1）通过编制新的衡量标准和应用新技术来构建更精确的管理式医疗措施，改善市场中管理式医疗活动的衡量标准，（2）研究管理式医疗的增长对医疗保健市场绩效的影响，包括研究对患者和结果的具体护理措施，及（3）评估管理式医疗成长的立法及规管决定因素的影响。该项目将推进管理式保健计量的状况，并将提供具体的量化证据，说明管理式保健对保健市场的影响，以及具体政策对管理式保健的影响。 这样做将有助于政策制定者、公共和私人购买者、管理者和其他卫生保健领导人评估管理式保健政策的选择。 我们的目标包括：1.编制和评估管理式护理活动的广泛措施。 这些数据将包括各种计划类型的流行率和市场份额数据，计划的具体成本降低活动数据，如对供应商选择的限制，人头费和利用管理，以及计划之间的竞争数据。 2.综合现有的措施，以制定新的，更精确的措施，HMO活动的具体和管理式护理活动更广泛。 我们将特别注重制定长期有效的措施。 3.研究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，包括自愿提供者法、选择自由法、强制性福利、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.