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Health Services Research--September 2004

Roger Feldman and colleagues Stephen Parente and Jon Christianson, from the Carlson School of Management, have published the early results from their national study of consumer-driven health plans (CDHPs). In a set of three papers in Health Services Research, the University of Minnesota researchers provided valuable, unbiased information to the policy and research community about the potential for CDHPs to take hold.  
 

Background: The unabated rise in medication costs particularly affects older persons with chronic conditions that require long-term medication use, but how prescription benefits affect medication adherence for such persons has received limited study.

Objective: We sought to study the relationship among prescription benefit status, health, and medication acquisition in a sample of elderly HMO enrollees with 1 or more common, chronic conditions.

This paper uses data from the 1997 National Survey of America's Families to examine the effects of the various forms of mandatory Medicaid managed care on access and use among beneficiaries not receiving Supplemental Security Income or Medicare benefits. The results show that mandatory health maintenance organization (HMO) programs have had a positive impact on both children and adults, particularly when compared to Medicaid fee-for-service plans.

Evaluations of health insurance market reforms have tended to neglect the critical role of independent agents, and have failed, so far, to directly observe market behavior. This article reports on an initial attempt to assess the impact of health insurance market reforms through structured contacts with insurance agents. A small employer was trained to contact a stratified random sampling of agents in eight states with varying market rules, to inquire about insurance purchase for a group of three and an individual, under a scenario that presented various elevated risk factors.

When first implemented in Minneapolis and St. Paul, Minnesota, the Buyers Health Care Action Group's (BHCAG) purchasing approach received considerable attention as an employer-managed, consumer-driven health care model embodying many of the principles of managed competition. First BHCAG and, later, a for-profit management company attempted to export this model to other communities. Their efforts were met with resistance from local hospitals and, in many cases, apathy by employers who were expected to be supportive.

OBJECTIVE: To examine the organizational, political, and community characteristics that facilitate or impede community progress in developing a coordinative network of health services for trauma delivery. STUDY SETTING/DESIGN: A comparative case study design was used to examine trauma network development in 6 U.S. cities with a population of 1,000,000 or more. Five key coordinative activities were selected for study. Each study site varied in the set of activities that had been implemented.

Providing all beneficial care to those who need it is rapidly becoming unaffordable, even for a nation as rich as the United States. The highly decentralized U.S. payment system is unique in its lack of effective levers for limiting health care spending, and managed care has largely been ineffective. A different solution, considered extreme by many in the United States, is rationing.

The Balanced Budget Act (BBA) of 1997 initiated several changes to Medicare payment policy in an effort to slow growth of hospital Medicare payments and ensure the future of the Medicare Hospital Insurance Trust Fund.  Although subsequent federal legislation relaxed some original proposals, restored funds were limited and directed to specific types of hospitals.  In addition, these Medicare policy changes came at a time when hospitals faced private sector payment constraints.  This paper assesses the short-term effects to those observed in the early 1980s during implementatio