We conducted multivariate analyses to examine whether high health maintenance organization (HMO) penetration and large share of for-profit health plans in a market reduced hospital cost and revenue growth rates between 1989 and 1998. We found that hospitals in high HMO areas experienced revenue and cost growth rates that were 21 and 18 percentage points, respectively, below hospitals in low HMO areas. We also found that, conditional on overall HMO penetration level, hospitals in areas with high for-profit HMO penetration experienced revenue and cost growth rates that were 10 percentage points below hospitals in areas with low for-profit penetration areas; the difference was especially evident within high HMO penetration areas.
References
1.
Accenture Group.2001. An Assessment of Health Coverage Industry Trends and Carefirst's Strategic Response.The Accenture Report Nov. 16.
2.
BakerL.C.1999. Association of Managed Care Market Share and Health Expenditures for Fee-for-Service Medicare Patients.Journal of the American Medical Association281 (5): 432–437.
3.
BamezaiA., ZwanzigerJ., MelnickG.A., and MannJ.M.. 1999. Price Competition and Hospital Cost Growth in the United States (1989-1994).Health Economics8 (3): 233–243.
4.
BuerhausP.I., StaigerD.O., and AuerbachD.I.. 2000. Implications of an Aging Registered Nurse Workforce.Journal of the American Medical Association283 (22): 2948–2954.
5.
Congressional Budget Office (CBO).1995. The Effects of Managed Care and Managed Competition.CBO Memorandum.Washington, D.C.: U.S. Government Printing Office.
6.
CutlerD.M., and McClellanM.. 1996. The Determinants of Technological Change in Heart Attack Treatment.NBER Working Paper #5751.Cambridge, Mass.: National Bureau of Economic Research (NBER).
7.
CutlerD.M., McClellanM., and NewhouseJ.P.. 2000. How Does Managed Care Do It?Rand Journal of Economics31 (3): 526–548.
8.
DranoveD., SimonC.J., and WhiteW.D.. 2002. Is Managed Care Leading to Consolidation in Health Care Markets?Health Services Research37 (3): 573–594.
9.
DuanN.1982. Smearing Estimate: A Nonparametric Retransformation Method.Journal of the American Statistical Association78: 605–610.
10.
GaskinD.J., and HadleyJ.. 1997. The Impact of HMO Penetration on the Rate of Hospital Cost Inflation, 1985-1993.Inquiry34 (3): 205–216.
11.
GliedS.2000. Managed Care. In Handbook of Health Economics, CulyerA.J., and New-houseJ.P., eds. Amsterdam: Elsevier.
12.
GrannemanT.W., BrownR.S., and PaulyM.. 1986. Estimating Hospital Costs.Journal of Health Economics5: 107–127.
13.
GreeneW.H.1997. Econometric Analysis.Upper Saddle River, N.J.: Prentice-Hall.
14.
LuftH.S., and MaerkiS.C.. 1984. The Competitiveness of Hospital Markets.Contemporary Policy Issues3: 83–94.
15.
MarstellerJ.A., BovbjergR.A., and NicholsL.M.. 1998. Nonprofit Conversion: Theory, Evidence, and State Policy Options.Health Services Research33: 1495–1535.
16.
MillerR.H., and LuftH.S.. 1997. Does Managed Care Lead to Better or Worse Quality of Care?Health Affairs16 (1): 1–23.
17.
MillerR.H., and LuftH.S.. 2002. HMO Plan Performance Update: An Analysis of the Literature, 1997-2001.Health Affairs21 (1): 63–86.
18.
NewhouseJ.P.1993. Free for All? Lessons From the Rand Health Insurance Experiment.Cambridge, Mass.: Harvard University Press.
19.
PhibbsC.S., and RobinsonJ.C.. 1993. A Variable-Radius Measure of Local Hospital Market Structure.Health Services Research28: 313–324.
20.
SchrammC.2001. Blue Cross Conversion: Policy Considerations Arising from a Sale of the Maryland Plan.The Abell Foundation Report November.
21.
ThorpeK.E., SeiberE.E., and FlorenceC.S.. 2001. The Impact of HMOs on Hospital-Based Uncompensated Care.Journal of Health Politics, Policy and Law26 (3): 543–555.
22.
WeisbrodB.A.1988. The Nonprofit Economy.Cambridge, Mass.: Harvard University Press.
23.
ZwanzigerJ., and MelnickG.A.. 1988. The Effects of Hospital Competition and the Medicare PPS Program on Hospital Cost Behavior in California.Journal of Health Economics7: 301–320.
24.
ZwanzigerJ., MelnickG.A., and BamezaiA.. 2000. The Effect of Selective Contracting on Hospital Costs and Revenues.Health Services Research35 (4): 849–867.
