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Health Maintenance Organisations: Just What the Doctor Ordered?

Published online by Cambridge University Press:  20 January 2009

Roland Petchey
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Abstract

Following its recent reorganisation of the management of the hospital sector of the NHS, the Government is currently engaged in a review of the primary health care sector. Certain of its proposals may be interpreted as suggesting movement towards a system modelled on American-style Health Maintenance Organisations (HMOs). This article seeks to explore the context in which HMOs have developed, to assess their current performance and to evaluate their potential impact on the health delivery system. It suggests that they must be understood primarily in the context of initiatives aimed at reducing health expenditure, and finds that the cost advantages claimed for them are achieved through reduced utilisation rather than through greater efficiency. It also argues that this reduced utilisation is likely to increase inequalities in health care.

Type
Articles
Information
Journal of Social Policy , Volume 16 , Issue 4 , October 1987 , pp. 489 - 507
Copyright
Copyright © Cambridge University Press 1987

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References

REFERENCES

Anderson, G. and Steinberg, E. (1984), ‘To buy or not to buy: technology acquisition under prospective payment’. New England Journal of Medicine, 311:3, 182–5.CrossRefGoogle ScholarPubMed
Bergen, S.S. and Roth, A.C. (1984), ‘Prospective payment and the university hospital’, New England Journal of Medicine, 310:5, 316–8.CrossRefGoogle ScholarPubMed
Brown, L.D. (1981), ‘Competition and health care cost containment’, Milbank Memorial Fund Quarterly, 59:2, 145–89.CrossRefGoogle Scholar
Broyles, R.W. and Rosko, M.D. (1985), ‘A qualitative assessment of the Medicare prospective payment system’, Sociol Science and Medicine, 20:11, 1185–90.CrossRefGoogle ScholarPubMed
Butler, R. (1986), Good Health, Adam Smith Institute, London.Google Scholar
Cameron, J.M. (1985), ‘The indirect costs of graduate medical education’, New England Journal of Medicine, 312:19, 1233–8.CrossRefGoogle ScholarPubMed
Corn, R.F. (1980), ‘Quality control of hospital discharge data’, Medical Care, 18:4, 416–26.CrossRefGoogle ScholarPubMed
Corn, R.F. (1981), ‘The sensitivity of prospective hospital reimbursement to errors in patient data’, Inquiry, 18:3, 351–60.Google ScholarPubMed
Coulton, C.J., McClish, D., Doremus, H., Powell, S., Smookler, S. and Jackson, D.L. (1985), ‘Implications of DRGs for medical intensive care’, Medical Care, 23:8, 977–85.CrossRefGoogle ScholarPubMed
Davies, A.R., Ware, J.E., Brook, R.H., Peterson, J.R. and Newhouse, J.P. (1986), ‘Consumer acceptance of pre-paid and fee-for-service medical care: results from a randomised controlled trial’, Health Services Research, 21:3, 429–52.Google Scholar
Department of Health and Social Security (DHSS, 1983), NHS Management Inquiry Report, (Chair: Roy Griffiths), DHSS, London.Google Scholar
Department of Health and Social Security, Scottish Office, Welsh Office and Northern Ireland Office (DHSS, 1986) Primary Health Care: An Agenda for Discussion, Cmnd 9771, HMSO, London.Google Scholar
Dunham, A. and Morone, J. (1983), ‘D.R.G. Evaluation: Political Evolution’, Health Research and Education Trust of New Jersey, Princeton.Google Scholar
Dutton, D. (1986), ‘Financial, organisational and professional factors affecting health care utilisation’, Social Science and Medicine, 23:7, 721–35.CrossRefGoogle Scholar
Financial Times, ‘New Medicine for the NHS’ (editorial), 29 07, 1986, p.20.Google Scholar
Garber, A.M., Fuchs, V.R., and Silverman, M.D. (1984), ‘Case-mix, costs and outcomes: differences between faculty and community services in a university hospital’, New England Journal of Medicine, 310:19, 1231–7.CrossRefGoogle ScholarPubMed
Health Service Journal (Editorial), ‘Green Paper Tiger’, 24 04, 1986, p.537.Google Scholar
Hennelly, V.D. and Boxerman, S.B. (1983), ‘Out-of-plan use and disenrollment: outgrowths of dissatisfaction with a prepaid group plan, Medical Care, 21:3, 348–59.CrossRefGoogle ScholarPubMed
Horn, S.D., Bulkley, G., Sharkey, P.D., Chambers, A.F., Horn, R.A. and Schramm, C.J. (1985), ‘Interhospital differences in severity of illness: problems for prospective payment based on diagnosis-related groups, New England Journal of Medicine, 313:120–4.CrossRefGoogle ScholarPubMed
Horn, S.D., Horn, R.A., Sharkey, P.D., Beall, R.J., Hoff, J.S. and Rosenstein, B.J. (1986), ‘Misclassification problems in diagnosis-related groups’. New England Journal of Medicine, 314:8, 484–7.CrossRefGoogle ScholarPubMed
Iglehart, J.K. (1984), ‘HMOs (for-profit and not-for-profit) on the move’, New England Journal of Medicine, 310:18, 1203–8.CrossRefGoogle ScholarPubMed
Iglehart, J.K. (1985), ‘Medicare turns to HMOs’, New England Journal of Medicine, 312:2, 132–6.CrossRefGoogle ScholarPubMed
Iglehart, J.K. (1986), ‘Early experience with prospective payment of hospitals’, New England Journal of Medicine. 314:22, 1460–64.CrossRefGoogle ScholarPubMed
Jackson-Beeck, M. and Kleinman, J.H. (1983), ‘Evidence for self-selection among health maintenance organisation enrolees’, Journal of the American Medical Association, 250:20, 2826–9.CrossRefGoogle Scholar
Jowell, R. and Witherspoon, S. (eds) (1985), British Social Attitudes: the 1985 Report, Gower, London.Google Scholar
Kemper, D.W. (1982), ‘Self-care education: impact on HMO costs’. Medical Care. 21:7. 710–18.CrossRefGoogle Scholar
Luft, H.S. (1980), ‘Trends in medical care costs: do HMOs lower the rate of growth?’ Medical Care, 18:1, 1–16.CrossRefGoogle ScholarPubMed
Luft, H.S. (1982), ‘Health maintenance organisations and the rationing of medical care’, Milbank Memorial Fund Quarterly, 60:4, 268–306.CrossRefGoogle ScholarPubMed
Manning, W.G., Leibowitz, A., Goldberg, G.A., Rogers, W.H. and Newhouse, J.P. (1984), ‘A controlled trial of the effect of a prepaid group practice on use of services’, New England Journal of Medicine, 310:23, 1505–10.CrossRefGoogle ScholarPubMed
, T.R. and Mayer, G.G. (1986), ‘HMOs: origins and development’, New England Journal of Medicine, 312:9, 590–4.Google Scholar
Mechanic, D., Weiss, N. and Cleary, P.D. (1983), ‘The growth of HMOs: issues of enrollment and disenrollment’, Medical Care. 21:3, 338–47.CrossRefGoogle ScholarPubMed
Newhouse, J.P., Manning, W.G., Morris, C.N., Orr, L.L., Duan, N., Keeler, E.B., Leibowitz, A., Marquis, K.H., Marquis, M.S., Phelps, C.E., and Brook, R.H. (1981), ‘Some interim results from a controlled trial of cost sharing in health insurance’, New England Journal of Medicine, 305:25, 1501–7.CrossRefGoogle ScholarPubMed
O'Grady, K.F., Manning, W.G., Newhouse, J.P. and Brook, R.H. (1985), ‘The impact of cost sharing on emergency department use’, New England Journal of Medicine, 313:8, 484–90.CrossRefGoogle ScholarPubMed
Petchey, R.P. (1986), ‘The Griffiths reorganisation of the NHS: Fowlerism by stealth?’ Critical Social Policy, 17:2, 87–101.CrossRefGoogle Scholar
Relman, A.S. (1980), ‘The new medical-industrial complex’. New England Journal of Medicine, 303:17, 963–70.CrossRefGoogle ScholarPubMed
Rosko, M.D. (1984), ‘Cost-shifting under prospective payment’, paper presented to the International Health Economics Conference, San Juan, 1984, cited in R.W. Broyles and M.D. Rosko (1985).Google Scholar
Salmon, J.W. (1984), ‘Organising medical care for profit’, in McKinley, J.B. (ed), Issues in the Political Economy of Health Care, Tavistock, London.Google Scholar
Sapolsky, H. and Altman, D. et al. (1981), ‘Corporate attitudes toward health care costs’, Milbank Memorial Fund Quarterly, 59, 561–585.CrossRefGoogle ScholarPubMed
Schiff, R.L., Ansell, D.A., Schlosser, J.E., Idris, A.G., Morrison, A. and Whitman, S. (1986), ‘Transfers to a public hospital’, New England Journal of Medicine, 314:9, 552–7.CrossRefGoogle ScholarPubMed
Schwartz, W.B., Newhouse, J.P. and Williams, A.F. (1985), ‘Is the teaching hospital an endangered species?’, New England Journal of Medicine, 313:3, 157–62.CrossRefGoogle ScholarPubMed
Simborg, D. (1981), ‘DRG creep: a new hospital-acquired disease’, New England Journal of Medicine, 304:26, 1602–4.CrossRefGoogle ScholarPubMed
Siminoff, L. (1986), ‘Competition and primary care in the United States: separating fact from fantasy’, International Journal of Health Services, 16:1. 57–69.CrossRefGoogle Scholar
Starr, P. (1982), The Social Transformation of American Medicine, Basic Books, New York.Google Scholar
Stern, R.S. and Epstein, A.M. (1986), ‘Institutional responses to prospective payment based on diagnosis-related groups’, New England Journal of Medicine, 312:10, 621–7.CrossRefGoogle Scholar
Thompson, J.D., Fetter, R.G. and Mross, C.D. (1975), ‘Case mix and resource use’, Inquiry, 12:3, 300–312.Google ScholarPubMed
Hart, J. Tudor (1971), ‘The inverse care law’, Lancet, 27 02 1971, 405–12.CrossRefGoogle ScholarPubMed
Valdez, R.B., Brook, R.H., Rogers, W.R., Ware, J.E., Keeler, E.B., Sherbourne, C.A., Lohr, K.N., Goldberg, G.A., Camp, P. and Newhouse, J.P. (1985), ‘Consequences of cost-sharing for children's health’, Paediatrics, 75:5, 952–61.CrossRefGoogle ScholarPubMed
Vladeck, B.C. (1976), ‘On cutting the cost of medical assistance’, Policy Analysis, 24:2, 497–8.Google Scholar
Ware, J.E., Brook, R.H., Rogers, W.H., Keeler, E.B., Davies, A.R., Sherbourne, C.D., Goldberg, G.A., Camp, P. and Newhouse, J.P. (1986), ‘Comparison of health outcomes at a health maintenance organisation with those of fee-for-service care’, Lancet, 3 05 1986, 1017–22.CrossRefGoogle Scholar