Health Maintenance Organizations

Publication Title: 
Inquiry: A Journal of Medical Care Organization, Provision and Financing

Catholic hospitals maintain a significant presence in delivering hospital services in the United States, but little is known about the ways they differ from other ownership forms in similar market environments. This paper analyzes characteristics of Catholic, other private nonprofit, and investor-owned hospitals in metropolitan areas of the United States to identify the extent to which Catholic hospitals differ from other ownership types on three dimensions of mission-driven identity--access, stigmatized, and compassionate care services.

Author(s): 
White, K. R.
Begun, J. W.
Publication Title: 
Stanford Law Review

In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs.

Author(s): 
White, K. A.
Publication Title: 
Telemedicine Today

In summary, the quality of care and satisfaction measures of the two systems are remarkable for what they are not--that is, not different. They suggest no difference between a culturally accepted model of care, with roots extending deep into human experience, both personal and traditional, and one based on a radical departure therefrom--care in the physical absence of a carer. They suggest, they do not indicate, because the study was not designed as a direct comparison. Numbers were small. Other flaws are evident.

Author(s): 
Harris, G.
Publication Title: 
American Journal of Public Health

OBJECTIVES: This study examined the impact of drug coverage generosity on older persons' prescription events (fills) and expenditures. METHODS: A cross-sectional study was conducted of 6237 older persons from the 1995 Medicare Current Beneficiary Survey. Dependent variables were per capita prescription events and expenditures. Independent variables were insurance type and drug coverage generosity. Control variables included sociodemographic and health status factors.

Author(s): 
Artz, Margaret B.
Hadsall, Ronald S.
Schondelmeyer, Stephen W.
Publication Title: 
Medical care research and review: MCRR

The authors examine the generosity of private employer health insurance coverage using data from two large national surveys of employers. Generosity is measured as the expected out-of-pocket share of medical expenditures for a standard population, given the provisions of the coverage. On average, those covered by employer-sponsored insurance can expect to pay 25 percent of expenditures out of pocket. There is little variability across plans in this share, though plans offered by smaller employers are somewhat less generous than those offered by larger employers.

Author(s): 
Gabel, Jon R.
Long, Stephen H.
Marquis, M. Susan
Publication Title: 
International Journal of Health Care Finance and Economics

This paper addresses two seeming paradoxes in the realm of employer-provided health insurance: First, businesses consistently claim that they bear the burden of the insurance they provide for employees, despite theory and empirical evidence indicating that workers bear the full incidence. Second, benefit generosity and the percentage of premiums paid by employers have decreased in recent decades, despite the preferential tax treatment of employer-paid benefits relative to wages-trends unexplained by the standard incidence model.

Author(s): 
Sommers, Benjamin D.
Publication Title: 
Health Services Research

OBJECTIVE: To evaluate the role of health plan benefit design and price on consumers' decisions to purchase health insurance in the nongroup market and their choice of plan. DATA SOURCES AND STUDY SETTING: Administrative data from the three largest nongroup insurers in California and survey data about those insured in the nongroup market and the uninsured in California. STUDY DESIGN: We fit a nested logit model to examine the effects of plan characteristics on consumer choice while accounting for substitutability among certain groups of products.

Author(s): 
Marquis, M. Susan
Buntin, Melinda Beeuwkes
Escarce, JosÈ J.
Kapur, Kanika
Publication Title: 
Health Affairs (Project Hope)

Just under seven million Americans acquired private insurance through the new health insurance exchanges, or Marketplaces, in 2014. The exchange plans are required to cover essential health benefits, including prescription drugs. However, the generosity of prescription drug coverage in the plans has not been well described. Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum).

Author(s): 
Buttorff, Christine
Andersen, Martin S.
Riggs, Kevin R.
Alexander, G. Caleb
Publication Title: 
American Heart Journal

The reuse of percutaneous transluminal coronary angioplasty (PTCA) balloon catheters has recently been proposed as a way of containing costs. Our aim was to examine patient acceptability of this strategy. We asked 100 consecutive patients scheduled for potential or definite PTCA whether they would permit the use of sterilized, reused balloon catheters. We collected demographic, clinical, angiographic, and insurance-status data on all patients. Sixty-eight patients responded that they would have allowed reused equipment (group 1). Thirty-two patients would have refused (group 2).

Author(s): 
Vaitkus, P. T.
Publication Title: 
BMC complementary and alternative medicine

BACKGROUND: Functional Bowel Disorders (FBD) are chronic disorders that are difficult to treat and manage. Many patients and doctors are dissatisfied with the level of improvement in symptoms that can be achieved with standard medical care which may lead them to seek alternatives for care. There are currently no data on the types of Complementary and Alternative Medicine (CAM) used for FBDs other than Irritable Bowel Syndrome (IBS), or on the economic costs of CAM treatments.

Author(s): 
van Tilburg, Miranda A. L.
Palsson, Olafur S.
Levy, Rona L.
Feld, Andrew D.
Turner, Marsha J.
Drossman, Douglas A.
Whitehead, William E.

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