Centro de Documentacion de Fundación MAPFRE - A Comparison of HMO efficiencies as a function of provider autonomy

MAP20071505329

A Comparison of HMO efficiencies as a function of provider autonomy / Patrick L. Brockett... [et al.]

Current debates in the insurance and public policy literatures over health care financing and cost control measures continue to focus on managed care and HMOs (Health Maintenance Organization). The lower utilization rates found in HMOs have generally been attribute to the organization's incentive to eliminate all unnecessary medical services. As a consequence HMOs are often considered to be a more efficient arragement for delivering heatl care. However , is it important to make a distinction between utilization and efficiency. In this article, the efficiencies of two major classes on HMO arragements are compared using " game-theoretic" data envelopment analysis (DEA) models. While other studies confirm that absolute costs to insurance firms and sponsoring companies are lowered using HMOs, our empirical findings suggest that, within this framework, efficiency generally becomes worse when provider autonomy is restricted. This hould give new fuel to the insurance companies providing free-for-service(FFS) indemnification plans in their marketplace contentions

En: The Journal of risk and insurance. - Orlando. - Volume 71, number 1, March 2004 ; p. 1-19

1. Servicios asistenciales . 2. Presupuestos . 3. Empresas de seguros . 4. Seguro de asistencia sanitaria . 5. Asistencia sanitaria . 6. Control de costes . 7. Estados Unidos . I. Brockett, Patrick L. . II. Title. III. Título: The Journal of risk and insurance.