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Health insurance contracts may restrict consumers' choice of medical provider (e.g., hospital) in order to minimize moral hazard inefficiencies. In this article, I assess the economic value of this strategy by comparing the estimated 'option value' that consumers assign to provider choice to the negotiated discounts that insurers can achieve by negotiating with a restricted set of providers (i.e., volume discounts). Using a panel of federal employees' health plan choices from 1999 to 2003, I show that the practice of selective contracting (SC) with a limited set of hospitals reduced health maintenance organization (HMO) plans' expected utility by $62-$118, on average, for a standard reduction in the provider choice set. I also conduct simulations which show that by 2003 health plans using SC were theoretically unable to achieve sufficiently large volume discounts from hospital providers to fully compensate for the associated utility losses. My results help to explain the flight from HMO enrollments that occurred in the early 2000s. (JEL I10, I11, LI5, D83, D12), I. INTRODUCTION AND OVERVIEW Health insurance contracts may restrict consumers' choice of medical provider in order to minimize moral hazard. For example, consumers who are insured for their marginal healthcare [...]

The implications of newly enacted law of the Affordable Care Act (ACA) to bring about the most extensive changes in the U.S. health care system which would require the development of larger integrated delivery organizations, preferably accountable care organizations (ACOs) are reviewed. The development of ACOs could possibly have crucial implications over the next few years for the practice of medicine, patients' experience of health care and health care costs in the Unites States which might be critical for designing an effective model of future health care system.

The article presents the origin, role, design and development of Chinese Activist Training, an effort by 1199SEIU United Healthcare Workers East (UHE). Education and training has played a vital role in the organizing of Chinese home care workers.

For the past six months, James Spurlock, a solo family physician and part-time emergency physician in Woodbury, TN, has had access to a web-based, statewide health record that covers all [...]

The impact of capitating the usual source of care of enrollees in health maintenance organizations (HMOs) is examined.

A new strategy for the selection of Medicare Health Maintenance Organisation (HMO) enrollees based on average costs between new Medicare HMO enrollees and Medicare fee-for-service stayers is analyzed.

Incentive contracts for gatekeepers who control patient access to specialist medical services provide too-weak incentives to investigate cost further when the expected cost of treatment is greater than the benefit. [...]

The influence of health maintenance organizations and other managed care organizations on the treatment patterns provided to the patients is observed. A case where common therapies are used for heart-attack patients is considered.

An important design and management problem in a health care centre where a set of services, required by one or more categories of users in different but predetermined sequences are provided. The effectiveness of the methodology in improving the management of transfusion centre is described.

Recent trends in mental-health care have increased the need for practical depression instruments. The Depression--Arkansas (D-ARK), a brief, economical, multipurpose instrument, has been validated for assessing major depressive disorder (MDD) and depressive-symptom severity. Psychometric properties of the D-ARK were compared with standard depression scales (Beck Depression Inventory and Geriatric Depression Scale) among 294 adult and 193 senior primary-care patients, respectively, and 163 patients enrolled in cognitive-behavioral depression classes. The severity scale displayed adequate internal reliability (coefficient [alpha] = .81 -.86), high correlation with the BDI-2 (r = .78-.83) and GDS (r = .75), and similar factor structure to the BDI-2. The D-ARK was calibrated against the BDI-2 and GDS, providing familiar severity category cutpoints with the new instrument. This study yields further data supporting the reliability, validity, and practical utility of the D-ARK. Keywords: adult; aged; depression; health-maintenance organization; questionnaires; psychological tests; psychometrics; reproducibility of results

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed.

A large HMO's financial reporting system was geared solely to providing information needed for external regulatory reporting. The system was unable to provide the information needed to effectively manage the HMO's health centers and their constituent medical departments. This paper describes the development by the HMO of a new financial reporting system designed to provide the detailed information needed to manage its health center operations. Design of the system required consideration of appropriate ways to measure departmental revenues, resolve information system issues, and allocate expenses to departments. The new system provided health center administrators with a tool that enabled them to focus on improving the organization's decision making and its cost effectiveness., Many organizations in the health care field are facing tremendous economic pressures. In the current environment, knowledge of an organization's costs has become increasingly important (West & West, 1997). This [...]

Reserach on 77 organizations find that those health service organizations such as hospitals which have a limited number of configurations are more financially successful than those characterized by a different set of configurations.

In the 1990s many health care organizations underwent reengineering. One of the unintended consequences of this process was a drop in employee morale. This article describes a project to improve morale in one hospital by fostering employees' constructive expression of dissatisfaction and of innovative ideas to senior leaders in the context of Employee Leadership Council meetings. Importantly, although formulated on the basis of employee suggestions, the hospital's president and chief executive officer initiated the project. After describing these councils, we examine the results of this experiment in employee-leadership exchange and explore the ramifications for the councils of the CEO's intimate involvement. Finally, we review lessons that might be transferable to other organizational settings as well as those that have implications for managerial understandings of organizational culture. Key words: organizational culture, participatory action research, employee satisfaction, leadership, organizational change, United States

This 1999 survey health maintenance organizations in the United States (representing 86% of the nations's enrollees) raises questions about their administrative and financial management practices.

Some health maintenance organizations are offering public health services including alliances with disease prevention programs. A study raised doubts about whether these integrated public health services may be successfully expanded nationwide.

The authors argue that the efficiency problems that plague California health maintenance organizations stem from the overlapping of independent practice association and health maintenance organization networks of physicians and hospitals. Potential solutions and their advantages and disadvantages are also discussed.

This study found that physicians do not spend more time on the administration of managed care plans than they had on other insurance-related issues before managed care was introduced.

Risk adjustment in the managed care health plan marketplace is discussed.

Issues discussed concern the over-utilization of medical services by psychopathological and emotionally distressed patients. Topics addressed include the goal of health maintenance organizations to better manage an aged population with mental instability, and the levels of psychopathology in a sample of patients in health maintenance organizations.

The notion of having two provider organizations take the full financial risk for medical services has become increasingly controversial. The bankruptcy of physician group Doctors Health System and the demise of the Florida Hospital Healthcare System's Premier Care are highly illustrative of why doctors ought to approach risk contracts with great caution especially if Medicare patients are involved. The two entities could not make it after starting out so well. Their experience shows that providers underestimate the challenges of delivering managed care on their own., Full financial risk for Medicare services torpedoed two physician groups. Are more such failures ahead? As profit margins shrink for health care organizations, the idea of taking full financial risk [...]

Group medical practices can reduce their frustrations with multiple health plans by doing their health maintenance organization (HMO) contracting through provider organizations such as independent practice associations. Such provider organizations may truly be beneficial provided they are financially solvent, have risk contracts and if contracting provider organization networks know their business. Medical practices may benefit from a number of tips on the advantages and pitfalls of dealing with contracting organizations., Wrestling With the Managed Care Octopus Part 6 San Ramon (CA) Primary Care, a 10-doctor group of internists and pediatricians, has done all its HMO contracting through the San Ramon-based [...]

Is this insurer a rapacious beast that's mauling doctors, patients, and hospitals as it gobbles its way to monopoly, or a benevolent behemoth that's greatly misunderstood? Since Aetna merged with [...]