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1: Health Care Financ Rev. 1993 Fall;15(1):7-23.Links

Do health maintenance organizations work for Medicare?

Brown RS, Clement DG, Hill JW, Retchin SM, Bergeron JW.

Mathematica Policy Research, Plainsboro, NJ 08536.

Since 1985, the Health Care Financing Administration (HCFA) has encouraged health maintenance organizations (HMOs) to provide Medicare coverage to enrolled beneficiaries for fixed prepaid premiums. Our evaluation shows that the risk program achieves some of its goals while not fulfilling others. We find that HMOs provide care of comparable quality to that delivered by free-for-service (FFS) providers using fewer health care resources. Enrollees experience substantially reduced out-of-pocket costs and greater coverage. However, because the capitation system does not account for the better health of those who enroll, the program does not save money for Medicare.

PMID: 10133710 [PubMed - indexed for MEDLINE]