HSC Revamps Its Web Site
A Window on HSC Research
SC has reorganized its web site by six topical areas to
make its growing number of analyses more accessible. The site (www.hschange.org)
allows users to select from three different perspectives-policy maker, researcher
or journalist-and to access bundles of related publications or those related
to a relevant policy issue. The site also has a robust search function so that
users can find information quickly on any topic.
Visitors to the site can choose to receive e-mail alerts about new analyses in topic areas of interest and can forward those analyses to colleagues.
The following sections below provide a window into the new site through the six topical areas.
Managed Care
Health Services Research
Vol. 35, No. 1, Part I, April 2000
MEDICAID MANAGED CARE
by Joy M. Grossman
lthough
the competitive threat from national plans is pervasive in 12 communities studied
as part of the Community Tracking Study, local plans in most sites continue
to retain strong, often dominant positions in historically concentrated markets.
According to an analysis by HSC, three strategies to increase market share and
market power were used in all sites in response to purchaser pressures for stable
premiums and provider choice and the threat of entry of plans: (1) consolidation/geographic
expansion; (2) price competition; and (3) product line/segment diversification
that focuses on broad networks and open-access products. In most markets, in
response to the demand for provider choice, the trend is away from ownership
and exclusive arrangements with providers. Although local plans are moving to
become full-service regional players, there is uncertainty about the ability
of all plans to sustain growth strategies at the expense of margins and organizational
stability, and to effectively manage care with broad networks.
This article is based on site visits conducted in 1996 and 1997.
Insurance Coverage
Issue Brief
No. 27, February 2000
WHO HAS A CHOICE OF HEALTH PLANS?
by Sally Trude
olicy
makers are concerned that consumers have no voice in the changing health care
system. They debate, however, whether the consumers' voice should be heard through
regulation or the marketplace. For market forces to work in the consumers' interest,
consumers must have a choice of plans. New survey data from HSC suggest that
more consumers have a choice of plans than is generally believed, and that the
proportion of consumers who have plan choice is increasing. According to HSC's
1998-1999 Household Survey, 64 percent of families have a choice of health plans-two
percentage points higher than two years ago. This Issue Brief reports on these
and other findings from HSC on consumer choice.
This Issue Brief is based on Household Surveys conducted in 1996-1997 and 1998-1999 and the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey.
Cost
Issue Brief
No. 23, November 1999
TRACKING HEALTH CARE COSTS: LONG-PREDICTED UPTURN APPEARS
by Paul B. Ginsburg
fter
three years of anticipation, health care cost trends have taken an upward turn.
In employment-based insurance, premium increases for 1999 were in the 5 percent
range, up from 3 percent for 1998. The rate of increase in underlying costs
of private insurance-lagged by one year-also rose by approximately two percentage
points. Many had expected a sharper upturn in premium increases than in underlying
cost increases. This would have heralded a turn in the insurance underwriting
cycle, which has not yet occurred. This Issue Brief tracks trends in the rate
of growth of health care costs and the experience with premiums for employment-based
health insurance and discusses the impact of these trends on consumers.
This Issue Brief is based on data from the 1999 Kaiser Family Foundation/Hospital Research and Educational Trust Survey of Employer-Based Health Plans, the Milliman & Robertson Health Cost Index, the Hay Benefits Report, the Department of Labor's Consumer Expenditure Survey and Bureau of Labor Statistics.
Access & Quality
Health Services Research
Vol. 35, No. 1, Part II, April 2000
DOES TYPE OF HEALTH INSURANCE AFFECT HEALTH CARE USE AND ASSESSMENTS AMONG THE PRIVATELY INSURED?
by James D. Reschovsky, Peter Kemper and Ha T. Tu
he
type of insurance people have-not just whether it is managed care but the type
of managed care-affects their use of services and their assessments of the care
they receive. Based on the Community Tracking Study Insurance Followback Survey,
a supplement to the Household Survey, HSC researchers found that as people move
from indemnity insurance to more managed care products, use of primary care
increases modestly, but use of specialists is reduced. Few differences were
found in preventive care, hospital use and surgeries. The likelihood of having
unmet or delayed care does not vary by insurance type, but enrollees in more
managed products are less likely to cite financial barriers and are more likely
to perceive problems in provider access, convenience and organizational factors.
Consumer assessments of care-including satisfaction with care and trust in physicians-are
generally lower under more managed products, particularly closed-model health
maintenance organizations (HMOs).
This article is based on the Community Tracking Study Household Survey conducted in 1996-1997 and the Insurance Followback Survey.
The Uninsured & The Poor
Issue Brief
No. 22, October 1999
WHO DECLINES EMPLOYER-SPONSORED HEALTH INSURANCE AND REMAINS UNINSURED?
by Peter J. Cunningham, Elizabeth Schaefer and Christopher Hogan
wenty
percent of all uninsured persons are offered health insurance by their employer
or a family member's employer, but choose not to enroll in the offered plan(s).
Most persons who do not "take up" or enroll in available employer-sponsored
coverage cite cost as the main reason. This Issue Brief, based on two surveys
conducted as part of the HSC Community Tracking Study, presents new findings
on who declines employer-sponsored coverage and is uninsured as a result. Given
the importance of cost in an individual's decision whether to enroll in employer-sponsored
coverage, policy makers need to consider ways to address the problem identified
by this study: low take-up rates among lower- income workers.
This Issue Brief is based on the Household Survey conducted in 1996-1997 and the 1997 Robert Wood Johnson Foundation Employer Health Insurance Survey.
Communities & Market Trends
Issue Brief
No. 26, January 2000
INSOLVENCY AND CHALLENGES OF REGULATING PROVIDERS THAT BEAR RISK
by Linda R. Brewster, Leslie A. Jackson and Cara S. Lesser
isk
contracting and capitation are two widely used financial mechanisms that give
incentives to health care providers to control costs. Risk-bearing arrangements
have failed in a number of communities, however. This has shaken local markets,
disrupting consumers' access to health care services and triggering losses for
physicians and hospitals. It also has raised questions about the adequacy of
related regulatory oversight, which holds important implications for local and
national policy makers. This Issue Brief examines failed risk-contracting arrangements
in two of the 12 communities that HSC tracks intensively-Northern New Jersey
and Orange County, Calif.-and describes how state policy makers have responded
to protect consumer and provider interests.
This Issue Brief is based on information obtained in site visits conducted in 1998 and 1999.
