Physician Payment Review Commission Research Articles

The Physician Payment Review Commission

The Physician Payment Review Commission

The Physician Payment Review Commission

The Physician Payment Review Commission

The regulation of preferred provider arrangements.

Research Article Health AffairsVol. 6, No. 3 The Regulation of Preferred Provider ArrangementsElizabeth S. Rolph, Paul B. Ginsburg, and Susan D. HosekPUBLISHED:Fall 1987No Accesshttps://doi.org/10.1377/hlthaff.6.3.32AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleAbstractPrologue:In a rapid fashion, preferred provider arrangements have become a new and central feature of medical care delivery reform. Nurtured largely by the private sector, these arrangements, also known by the derivative preferred provider organizations, represent a compromise between the freedom patients have enjoyed to seek treatment from any physician and the more restrictive practices of closed-panel plans that require their enrolled members to select a doctor who is employed by or contracts with the plan. One of the concerns among advocates of preferred provider arrangements, such as Rep. Ron Wyden (D-OR), has been whether state laws are impeding their implementation. In this report, three Rand Corporation researchers look specifically at this question. Their findings are a part of a large-scale study that Rand has under way involving preferred provider arrangements. The project is funded by the Department of Health and Human Services, with additional support from the Federal Trade Commission and the National Institute of Mental Health. Perhaps the most striking finding of the study is the vintage of state laws that are affecting the implementation of preferred provider arrangements. For the most part, they are not old statutes that are, unwittingly, impeding the proliferation of these new delivery arrangements. Rather, they are new laws that derived from recent deliberations of state legislatures. This finding raises questions about the appropriateness of federal intervention on behalf of preferred provider arrangements. Elizabeth Rolph, with a masters degree from the University of California, Berkeley, is a political scientist at Rand, where she has undertaken a variety of research projects designed to evaluate institutional effectiveness. Paul Ginsburg, a respected economist with a doctorate from Harvard University, left Rand last November to become executive director of the Physician Payment Review Commission. Susan Hosek, an economist at Rand with a master's degree from Northwestern University, has been involved in a range of health policy studies in the civilian and military health care systems.TOPICSRegulationInsurance market regulationHealth care providersLegislationMarketsEmployee Retirement Income Security ActInsurance providersQuality of carePaymentPreferred provider organizations Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 1 History Published online 1 January 1987 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF downloadCited byDefining Underinsurance: A Conceptual Framework for Policy and Empirical Analysis5 August 2016 | Medical Care Review, Vol. 50, No. 2