Grantee Publication

In the past few years managed care has become the dominant model of health care delivery in the United States. Large companies have spearheaded the move to managed care and have driven the increasing focus on cost containment, the emergence of new organizational forms and contracting arrangements, and efforts at measuring quality in health care systems. Nonetheless, few researchers have examined comprehensively the motivations and methods of large corporate purchasers.

Mental health services are underused relative to mental illness rates. We hypothesized a positive correlation between use of mental health services and community-level health care social capital. Community Tracking Study data from 43 cities (N = 43,278), merged with the National Profile of Local Health Departments and other sources, show that use of mental health services was greater when public health districts collaborated with managed care organizations and other community groups, independent of individual predictors and health care system variables.

Objective. Physician income is generally high, but quite variable; hence, physicians have divergent perspectives regarding health policy initiatives and market reforms that could affect their incomes. We investigated factors underlying the distribution of income within the physician population.

Medicare’s decentralized local coverage policy process leads to policy variation, raising serious equity and quality issues. The policy debate resembles a tug-of-war, with advocates favoring nationalization of all local policies or arguing for the status quo. We extensively analyzed thousands of local policies and surveyed Medicare’s contractors. We found that all local policies are not the same.

This study examines the impact of policy standardization on the market for Medicare supplemental, or "Medigap," policies. Prior to 1992, insurance carriers could sell any benefits they chose, so long as minimum benefit requirements were met. In July 1992, federal legislation was implemented that required all new Medigap policies to conform exactly to one of 10 standardized sets of benefits. Using pre- and post-standardized policy information from six states, this study analyzes the impact of this legislation.

Objectives. To determine the impact of introducing copayments on medical care use and expenditures for low-income, adult Medicaid beneficiaries. Data Sources/Study Setting. The Oregon Health Plan (OHP) implemented copayments and other benefit changes for some adult beneficiaries in February 2003. Study Design. Copayment effects were measured as the "difference-in-difference" in average monthly service use and expenditures among cohorts of OHP Standard (intervention) and Plus (comparison) beneficiaries. Data Collection/Extraction Methods.

Cost-effectiveness analysis (CEA) offers decision makers a structured, rational approach with which to improve the return on resources expended. But decades after its widespread promotion to the medical community, policy makers in the United States remain reluctant to use the approach formally. Indeed, the resistance to economic evidence in the United States in an era of evidence-based medicine in healthcare is perhaps the most notable development of all. This paper examines the resistance to CEA in the United States and explores ways in which to advance the field.

OBJECTIVE: To evaluate the influence of community- and family-level factors on racial/ethnic disparities in the uptake of nongroup (individual) health insurance. DATA SOURCES: Responses to the 1996-1997 Community Tracking Study Household Survey plus community-level descriptors from several sources including census data, the Area Resource File, and community and migrant health center Medicare cost reports.

Prior studies find that the growth of managed care through the early 1990s introduced a strong positive relationship between price and concentration in hospital markets. We hypothesize that the relaxation of constraints on consumer choice in response to a "managed care backlash" has diminished the price sensitivity of demand facing hospitals, reducing or possibly reversing the price-concentration relationship.

Inquiry - Spring 2005