MANAGED CARE PENETRATION IN RURAL SETTINGS

描述：管理式护理对 农村地区，特别是如果一个人超越了环SMSA的农村地区; 请参见第239页的表格。大部分的有效性和吸引力的管理 城市环境中的护理一直是谈判降低费用的能力。但这样 谈判假设该计划可以交给另一组供应商。 农村地区缺乏提供者的密度，特别是医院， 这样的谈判成功了。这项研究将利用更新 几年前的医生位置分析， 在北方平原和落基山脉西部，以及太平洋 西北部、中西部偏上地区、田纳西州和俄亥俄州。对于每种类型的提供者， 它们可以估计到该类型的最近的提供者的距离。然后使用 MEPS文件，以检查距离对利用率和支出的影响 使用标准的多部件模型。因为没有去一个比 将确定远距离提供者而不是近距离提供者。赫芬达尔指数可以 根据邮政编码级别信息进行计算，并汇总为 每个医生的拉链。 他们还将研究渗透率作为当地市场的函数 供应商的集中度、AAPCC和其他因素。自市场渗透以来 与市场规模密切相关，而规模既与结构有关， 的竞争和提供商的种类，他们将试图分离 这两种效果。

Description: There is substantially less penetration by managed care into rural areas, especially if one goes beyond the rural areas that ring SMSAs; see the table on page 239. Much of the effectiveness and appeal of managed care in urban settings has been the ability to negotiate lower fees. But such bargaining assumes that the plan can go to an alternative set of providers. Rural areas lack the kind of density of providers, esp. hospitals, that make such bargaining successful. The study will take advantage of the updating of the physician location analysis of several years ago to build data for states in the northern plains and Rocky Mountain west, as well as the Pacific Northwest, upper Mid-West, Tennessee, and Ohio. For each type of provider, they can estimate the distance to the nearest provider of that type. Then use MEPS files to examine the effect of distance on utilization and expenditures using standard multipart models. Thresholds for not traveling to a more distant provider over a closer one will be determined. Herfindahl indices can be calculated on the basis of zip code level information, and aggregated for the zips served by each physician. They will also examine the penetration rate as a function of local market concentration of providers, AAPCC and other factors. Since market penetration is strongly related to market size, and size is related to both the structure of competition and the kinds of providers available, they will try to separate the two effects.