|
|
| Home | Current Issue | Archives | Topic Collections | Search | Blog | Subscribe | Contact Us | Help |
Business Of Health |
PROLOGUE
The Business Of Health
PROLOGUE: The recent resurgence in health care spending, following an extended period when expenditure increases fell to record-low levels, underscores the impact of steps that took the teeth out of managed care. As Bradley Strunk and colleagues reported last fall in their Health Affairs Web-exclusive paper (26 September 2001), health care spending surged a whopping 7.2 percent in 2000, capping a three-year run of "significantly high growth." Notably, hospital inpatient spending, which increased at a rate of 2.8 percent in 2000, overtook prescription drugs as the primary health care cost driver. The return to accelerated cost inflation has been attributed, among other things, to health plans’ retreat from traditional managed care practices such as controlled utilization, the use of gatekeepers for specialty care, restricted provider panels, negotiated payments, and the push to grow plan enrollment even at the expense of short-term profitability (Debra Draper and colleagues, Health Affairs, Jan/Feb 02).
This changing dynamic could reflect a fundamental realignment in the relative bargaining positions of health plans and providers. Buoyed by strong consumer preference for maximum provider choice and by widely reported shortfalls in hospital capacity and workforce, some providers have seized the moment to renegotiate what they long viewed as lose-lose payment arrangements with health plans. However, many believe that the unfortunate fallout of this tectonic shift may be that health plans’ renewed drive to maintain profitability in a watered-down managed care environment could force employers providing health care coverage to increase employee cost sharing or reduce benefits, or both. Evidence of this increasingly restrictive, consumer-targeted strategy can already be seen in the implementation of tiered prescription drug plans.
The papers that follow separate perception from reality by providing a more nuanced assessment of trends in two staples of traditional managed care: integrated health care delivery and provider risk contracting. First, Lawton Burns and Mark Pauly draw lessons from the failed attempts at horizontal and vertical integration of the 1980s and 1990s to offer hospitals alternative strategies for achieving truly integrated delivery of health care services, including geographic co-location of specialties and services, greater use of information technology, and expanding the role of patients in coordinating their own care. Next, Robert Hurley, Joy Grossman, Timothy Lake, and Lawrence Casalino debunk the assertion that risk contracting is in virtual free-fall by providing empirical evidence of its continued relevance and viability in some local markets. For example, in "mature" markets, where risk contracting has long been embraced, risk arrangements persevere, although their scope has been redefined to exclude certain services while payments amounts have increased.
This article has been cited by other articles:
 |
|
 |
|
  D. Delia, A. Hall, T. Prinz, and J. Billings What Matters to Low-Income Patients in Ambulatory Care Facilities? Med Care Res Rev, September 1, 2004; 61(3): 352 - 375. [Abstract] [PDF]
|
|
| Home | | | Current Issue | | | Archives | | | Topic Collections | | | Search | | | Blog | | | Subscribe | | | Contact Us | | | Help |
|
© 2001-2002 Project
HOPE–The People-to-People Organization |
||||||||||||||||