Centro de Documentación de Fundación MAPFRE - Why are managed care plans less expensive : risk selection, utilization, or reimbursement?

MAP20071505330

Why are managed care plans less expensive : risk selection, utilization, or reimbursement? / Daniel Polsky, Sean Nicholson

This article develops a new method of decomposing the cost difference between HOM and non HMO plans into observed risk selection, unobserved risk selection, utilization differences, and differences in provider reimbursement rates. We implement this method using a large national sample of employers-sponsored health insurance enrollees from the Community Tracking Study Household Survey. We find no evidence that HMO plans attract a disproportionate share of low-risk medical expenditures per enrollee can be explained by the relatively low provider reimbursement rates paid by HMO plans. This indicates there may be little need for employers to risk adjust insurance premiums or otherwise restrict employee choice of plans types

En: The Journal of risk and insurance. - Orlando. - Volume 71, number 1, March 2004 ; p. 21-40

1. Asistencia . 2. Seguro de enfermedad . 3. Programas estatales . 4. Estados Unidos . I. Nicholson, Sean . II. Título. III. Título: The Journal of risk and insurance.