Potential effects of managed care on specialty practice at a university medical center

Article Abstract:

University medical centers may not be able to support the number of specialist faculty members that they did in 1992. Researchers analyzed the finances of the University of Michigan Medical Center and the revenues from specialty practices. In 1992, the university's health maintenance organization (HMO) had about 40,000 members. If the medical center supplied all specialty services for the HMO members, more than 250,000 members would be needed to maintain the 1992 specialty revenue and support the number of specialists in most fields. If the medical center supplied specialty services only for referrals for HMO members, more than 4 million members would be needed to support many specialties. If the center supplied all specialty services to 100,000 HMO members and only referral services to other members, enrollment would have to rise above 1 million to support several specialties. Because such HMO growth may not be realistic, universities may need to cut their faculty in medical specialties.

Medicine, Hospitals, University, University hospitals, Medical specialties

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Trends in health care coverage and financing and their implications for policy

Article Abstract:

The US health care system is heading for a crisis that only government intervention may be able to prevent. Since the introduction of managed care, the number of uninsured people has risen. Traditionally, physicians and hospitals could provide uncompensated care to such people because private insurance premiums would cover the cost. However, managed care does not pay as much and consequently, fewer physicians can provide uncompensated care. Welfare reform may also swell the ranks of the uninsured, as will cuts in Medicaid and Medicare spending. Congress may have to expand the subsidies for children's health insurance to include adults.

Analysis, Finance, Health insurance, Medical policy, Health policy

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The commercialization of prepaid group health care

Article Abstract:

Health maintenance organizations (HMOs) are prepaid managed care health plans designed to promote continuity of care, reduce physicians' financial incentives, improve medical practice, and lower the costs of care. Rather than compensating physicians with a fee-for-service plan, many HMOs simply pay salaries, then create financial incentives for physicians to control medical costs. HMOs benefit by selectively targeting young, healthy patients for enrollment. Almost 75% of HMOs operate for-profit, although non-profit plans appear to be more efficient and better-regarded by patients.

Health maintenance organizations

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