Preferred Provider Organization Plans Research Articles

Economic grand rounds: the costs of parity mandates for mental health and substance abuse insurance benefits.

Employer-sponsored health plans typically provide less coverage for mental health and substance abuse treatment than for medical or surgical treatment. The merits and costs of mandating parity, or equivalent coverage, for insurance benefits for mental health and substance abuse treatment have been a recent topic of significant public debate. This article presents cost estimates for a variety of comprehensive parity mandates, including parity for different diagnoses, benefit provisions, and types of health insurance delivery systems.

DIFFERENCES IN PRACTICE CHARACTERISTICS OF CAPITATION AND PPO PROVIDER DENTISTS

This article is the last in a series of three articles compiling the results of the 1995 Managed Care Marketplace Information Survey conducted by the ADA Council on Dental Practice. It addresses practice characteristics of dentists participating in capitation and preferred provider organization plans.

Factors Affecting Municipal Satisfaction with Health Care Plans

Rising health care costs are causing employers to search for alternatives to contain costs of health care benefits. Common alternatives to the traditional indemnity plans are health maintenance organizations (HMOs) and Preferred Provider Organizations (PPOs) Conventional wisdom suggests that satisfaction with alternatives is lower than with indemnity plans. This study examines levels of satisfaction with indemnity, HMO, and PPO plans based on a national survey of personnel directors and develops a model of factors that should influence satisfaction

Managed Care Plan Performance Since 1980

To compare the health care utilization, expenditure, quality of care, and satisfaction since 1980 of enrollees in managed care and indemnity plans. Studies selected met the following criteria: data from 1980 forward, private insurance or Medicare enrollees, a comparison group, a reasonable attempt at statistical adjustment for noncomparable managed care and indemnity plan enrollees, and peer-reviewed findings (with two exceptions). Few studies on preferred provider organization plan performance met the selection criteria. Compared with indemnity plans, health maintenance organization plans had somewhat lower hospital admission rates, 1% to 20% shorter hospital length of stay, the same or more physician office visits per enrollee, less use of expensive procedures and tests, greater use of preventive services, mixed results on outcomes, and somewhat lower enrollee satisfaction with services but higher satisfaction with costs. The evidence does not support the hypothesis that prepaid group practice or staff model health maintenance organizations are more effective than individual practice association or network model health maintenance organizations. Although this literature analysis found several clear patterns of results, several factors, including unmeasured selection bias, diverse and rapidly changing health plans and local market conditions, and relatively few research results, suggest that generalizations must be made with caution.

Health services use among the elderly under alternative health service delivery systems

This article compares patterns of health care utilization for hospitalizations and ambulatory care in a sample of 1855 urban, elderly, community residents who report obtaining their health care from one of four types of arrangements: a fee-for-service (FFS) physician, a hospital-based health maintenance organization, a network model HMO, or a preferred provider organization (PPO). Utilization rates reported by respondents at six month intervals over three years were adjusted for health and socioeconomic characteristics of enrollees. PPO plan members consistently have mean and total lengths of hospital stay one-third to one-half those of the others. Although rates of use of particular categories of ambulatory care vary across systems of care, total ambulatory care rates are highest for network model HMO plan members. Specific features of alternative delivery systems, rather than general model types, may have an impact on utilization rates and the costs of care.