Medical care expenditures under gatekeeper and point-of-service arrangements

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Show simple item record Kapur, Kanika Escarce, José J. Joyce, Geoffrey F. Van Vorst, Krista A. 2008-06-20T16:21:24Z 2008-06-20T16:21:24Z Copyright 2002, Published on behalf of Health Research and Educational Trust in cooperation with Academy Health en 2001-12
dc.identifier.citation Health Services Research en
dc.identifier.issn 0017-9124
dc.description.abstract OBJECTIVE: To compare expenditures for medical care in a closed-panel gatekeeper HMO and an open-panel point-of-service (POS) plan that share the same provider network. DATA SOURCE/STUDY SETTING: The two study HMOs are distinct product lines of a single managed care organization; both plans are commercial products. We used administrative data files from the study plans for 1994-95 to assess differences in total medical care expenditures and spending for five categories of services: physician services, inpatient hospital services, outpatient hospital services, prescription drugs, and other services. STUDY DESIGN: Multivariate analyses were based on the two-part model of the demand for medical care. The dependent variables in these models were expenditures in each of the five categories of services, and the independent variables were indicator variables for plan type and visit copayments, prescription drug copayment, distance to the nearest primary care physician (PCP), demographic characteristics, chronic conditions, area characteristics, and entry/exit indicator variables. PRINCIPAL FINDINGS: Total expenditures for medical care ranged from equal in both plans to 7 percent higher in the gatekeeper HMO (p < .10), depending on the copayments for physician visits. Expenditures were not higher in the POS plan for any of the five categories of services. These findings were robust to a wide range of sensitivity analyses. CONCLUSIONS: Direct patient access to specialists in POS plans does not necessarily result in higher medical care expenditures. When POS enrollees are required to choose PCPs, patient cost sharing, physician financial incentives, and utilization review may control expenditures without constraining direct patient access to providers. en
dc.format.extent 4640 bytes
dc.format.mimetype application/pdf
dc.language.iso en en
dc.publisher Blackwell en
dc.rights.uri Publisher's copyright policy en
dc.rights.uri en
dc.subject Access en
dc.subject Gatekeeper HMO en
dc.subject Point-of-service HMO en
dc.subject Medical care expenditures en
dc.subject.lcsh Health Maintenance Organizations en
dc.subject.lcsh Medical care--Finance en
dc.subject.lcsh Health services accessibility en
dc.title Medical care expenditures under gatekeeper and point-of-service arrangements en
dc.type Journal Article en
dc.internal.authorurl Kanika Kapur (web page) en
dc.internal.authorurl en
dc.internal.authorcontactother Email:; Tel: 353 1 716 4624 en
dc.internal.authorid UCD0012 en
dc.internal.availability Full text not available en
dc.internal.webversions Online provider's version en
dc.internal.webversions en
dc.status Peer reviewed en
dc.identifier.volume 36 en
dc.identifier.issue 6 en
dc.identifier.startpage 1037 en
dc.identifier.endpage 1057 en
dc.citation.other Part 1 en
dc.neeo.contributor Escarce|José J.|aut|
dc.neeo.contributor Joyce|Geoffrey F.|aut|
dc.neeo.contributor Kapur|Kanika|aut|UCD0012
dc.neeo.contributor Van Vorst|Krista A.|aut|

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