And the bad news?Managed care brings down traditional Medicare spending THERE GOES THE NEIGHBORHOOD. WHEN managed care moves into an area, health care spending appears to drop for Medicare beneficiaries served by the traditional fee-for-service program, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. a study published in the February 3 issue of the Journal of the American Medical Association JAMA: The Journal of the American Medical Association is an international peer-reviewed general medical journal, published 48 times per year by the American Medical Association. JAMA is the most widely circulated medical journal in the world. . The finding is surprising considering that, unlike managed care, traditional Medicare pays fixed prices for services and does not seek to improve the cost-efficiency of care. Researcher Laurence C. Baker, PhD, of Stanford University Stanford University, at Stanford, Calif.; coeducational; chartered 1885, opened 1891 as Leland Stanford Junior Univ. (still the legal name). The original campus was designed by Frederick Law Olmsted. David Starr Jordan was its first president. in Stanford, California Stanford is a census-designated place (CDP) in Santa Clara County, California, United States. The population was 13,315 at the 2000 census. Stanford is an unincorporated area of Santa Clara County and is adjacent to the city of Palo Alto. , looked at the relationship between increasing market penetration Noun 1. market penetration - the extent to which a product is recognized and bought by customers in a particular market penetration - the act of entering into or through something; "the penetration of upper management by women" by managed care organizations--specifically HMOs--and fee-for-service Medicare payments Noun 1. medicare payment - a check reimbursing an aged person for the expenses of health care medicare check bank check, check, cheque - a written order directing a bank to pay money; "he paid all his bills by check" . In examining health care spending data, Baker found that the percentage of fee-for-service expenditures paid by Medicare Part A (hospital care) and Medicare Part B (outpatient care) decreased as the market share of managed care organizations increased. The study covered 1990 to 1994, when the average HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, enrollment increased nationally from 15 to 21 percent. While not conclusive, the findings "could lead one to believe that the volume of services decreased, either in number or intensity," Baker says. He offers several explanations for the findings. "Managed care may ultimately drive all providers in an area to be more 'managed-care like' in their practice" he says. "Or managed care may contribute to the flow of information in a way that helps physicians find new ways of practicing. Or it may be that physicians are bombarded with so many different insurance companies that they develop a unified way to practice that affects all patients." In future studies, Baker plans to look at such factors as the volume of services and patient outcomes. The pressing question is whether the decrease in health care spending is in patients' best interest, a research undertaking Baker believes should be tackled on a diagnosis-by-diagnosis basis. "The goal would be to figure out what is useful about managed care and what is not." |
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