MANAGED COMPETITION IN FLORIDA HEALTH CARE: ITS STRENGTHS AND WEAKNESSES (original) (raw)

Managed Competition Theory as a Basis for Health Care Reform

Akron law review, 1994

are both principals in, and Mr. Pavarini is chair of, the Health Law Department of Schottenstein, Zox & Dunn, a Columbus, Ohio law firm. The authors gratefully acknowledge the capable research assistance of Nancy A. Brigner and Thomas H. Mallory. See infra pp. 26-33.

The Marketplace in Health Care Reform -- The Demographic Limitations of Managed Competition

New England Journal of Medicine, 1993

Background The theory of managed competition holds that the quality and economy of health care delivery will improve if independent provider groups compete for consumers. In sparsely populated areas where relatively few providers are required, however, it is not feasible to divide the provider community into competing groups. We examined the demographic features of health markets in the United States to see what proportion of the population lives in areas that might successfully support managed competition.

Managed competition in health care and the unfinished agenda

Health care financing review, 1986

A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent active agents on the demand side, called sponsors, that contract with the competing health care plans and continuously structure and adjust the market to overcome its tendencies to failure. A great deal remains to be done to achieve the goals envisioned by the "procompetition reformers."

The Effect of State Regulatory Policy on Competition in the Health Insurance Exchanges

Georgetown University-Graduate School of Arts & Sciences, 2017

In 2017, insurer participation in the health insurance exchanges established by the Affordable Care Act dramatically decreased due to the exit of three major insurers: UnitedHealthcare, Aetna, and Humana. As competition in the exchanges decreased, millions of people were left with only one insurer offering plans in their state and average premiums increased substantially. This study analyzes the relationship between state insurance regulatory policy and insurer participation and how the type of insurer participating in a state's exchange can affect competition. The study finds that there is not a clear association between a state's regulatory environment and the level of competition in the exchanges, but the participation of Medicaid insurers and Consumer Operated and Oriented Plans (Co-ops) in state exchanges is associated with increased competition. Additionally, this study finds that the greater the market share of the largest insurer in an exchange, the less competition there will be in that marketplace. This study sheds light on why competition varies in different parts of the country and offers specific recommendations for policymakers to encourage insurer participation in states with limited competition, with the aim of giving consumers more choice and more affordable premiums. iv

Competition policy in health care markets: navigating the enforcement and policy maze

Health affairs (Project Hope), 2014

US health care is in ferment. Private entities are merging, aligning, and coordinating in a wide array of configurations. At the same time, there is a great deal of policy change. This includes the federal government's Affordable Care Act, as well as actions by Medicare, state legislatures, and state agencies. The health system is built upon markets, which determine how (and how well) goods and services are delivered to consumers, so it is critical that these markets work as well as possible. As the primary federal antitrust enforcement agencies, the Federal Trade Commission and the Department of Justice are charged with ensuring that health care markets operate well, but they are not alone. The functioning of health care markets is also profoundly affected by other parts of the federal government (notably the Centers for Medicare and Medicaid Services) and by state legislation and regulation. In this current period of such dynamic change, it is particularly important for the an...

Competition and quality among managed care plans in the USA

International Journal for Quality in Health Care, 1998

This paper examines the popular idea that competition among managed care plans will lead not only to lower prices, but also to improved quality. We explore the likelihood that competition based on quality will occur and that better quality care will result. First, we discuss key elements of competitive theory and then we attempt to apply them to markets for health care coverage and care. We identify the conditions necessary for competition to have the desired effects and assess the extent to which those conditions do or can exist. We conclude that in the USA, many consumers have no choice among plans and, therefore, cannot select one based on quality. Moreover, the evidence suggests that as long as price varies among health plans, consumers who do have a choice will tend to emphasize price, not quality, in making their selections. We conclude with suggestions to increase the likelihood that quality can improve as a result of competition.

Economic Theory and Political Reality: Managed Competition and U.S. Health Policy

Politics <html_ent glyph="@amp;" ascii="&"/> Policy, 2006

During the 1992 campaign, candidate Bill Clinton made the strategic decision to embrace many aspects of an economic model called "managed competition" in his approach to health-care reform. Managed competition ideas did not die when Clinton's health plan expired. Instead, they informed the 1997 expansion of a demonstration project into the Medicare + Choice program. Today, the Medicare + Choice legacy lives on in the Medicare Advantage and prescription drug programs created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003. Shortcomings of the managed competition approach received little public attention during the debate over the Medicare Modernization Act, despite the fact that the record of Medicare + Choice is disappointing in a number of respects. There are serious questions about the ability of the managed competition approach to control costs and achieve equitable access to high-quality care. Nevertheless, the approach remains influential largely because of political considerations.

Studying the effects of health plan competition: Are available data resources up to the task?

Health Services Research

Objectives. To review the availability of data sources to study health plan competition in the United States. Data Sources. The literature on health plan competition was reviewed. Possible data sources to study health plan competition were evaluated. Experts in the field of health plan competition were contacted about their knowledge of existing data sources. Principal Findings. There is much more quantitative data available on HMO plans than on other types of health plans that are growing in popularity, such as PPOs. A key source for health plan data, state health insurance filings, lacks information on beneficiaries in non-HMO plans. Data on health plan quality is growing. In addition, case studies of particular markets is providing useful qualitative information on the dynamics of the health plan industry. Conclusions. The fragmentation of the health care market and the hesitancy of governments and private organizations to provide detailed information across markets and providers creates serious obstacles to the study of health plan competition.

US Medicaid managed care markets: explaining state policy choice variation

2011

State Medicaid programs transfer over $100 billion to private firms to manage the health care needs of beneficiaries every year. As a result of state policy choices, there is a great deal of variation among the states in the scope and use of managed care organizations to serve state Medicaid populations. This research answers the questions about what factors help to explain the variations among states; with a specific emphasis on both the role of interest group populations and bureaucratic capacity. The questions posed are answered utilizing pooled, cross-sectional time series analysis from 1997 to 2007 to test the relationship between Medicaid managed care policy choices and a variety of political, economic, demographic and governmental control variables. The findings from the models suggest that interest groups play an important role in explaining why states choose to use commercial for-profit managed care arrangements. The models also find that states with higher levels of bureaucratic capacity tend to rely less on the use of all forms of managed care in Medicaid contracting, and that state specific managed care markets are positively related to state managed care policy choices.