Portal de Periódicos da CAPES

A Plan for Rewarding Efficient HMOs

1988; Project HOPE; Volume: 7; Issue: 3 Linguagem: Inglês

10.1377/hlthaff.7.3.80

2694-233X

Stanley S. Wallack, Christopher P. Tompkins, Leonard Gruenberg,

Technology and Data Analysis

Prologue: The federal government's promotion of health maintenance organizations (HMOs) over the past eighteen years has lent credibility and tax dollars to the development of alternative delivery systems. Ever since the strong support articulated initially by Richard M. Nixon in a presidential health message delivered February 18,1971, the federal government has pursued the promotion of alternatives to fee-for-service care. In the early years, the government's encouragement was less than total It was slow to fashion policies that granted Medicare and Medicaid beneficiaries access to prepaid health plans, thus affording eligible persons the same choice that federal law compelled private employers of more than twenty-five workers to offer their employees. Since 1985, the Health Care Financing Administration (HCFA) has been waging an aggressive campaign to enroll Medicare beneficiaries in HMOs and other competitive medical plans. Several hundred HMOs have enrolled elderly people, but more plans have not. In this paper, Stanley Wallack and his colleagues at Brandéis University address the central reason why some HMOs have resisted movement into the Medicare market and why other plans have prospered by their decision to do so. Wallack, who holds a doctorate in economics from Washington University, is director of the Bigel Institute for Health Policy at Brandeis. This year he was on leave to serve as president of Lifeplans, Inc., an organization created in 1986 with Brandeis s assistance to work with insurance companies and delivery systems in the design and risk management of long-term care insurance products. Christopher Tompkins is a doctoral candidate in social welfare at Brandeis's Heller Graduate School and a research associate at the Bigel Institute. Leonard Gruenberg, who holds a doctorate in physics from Columbia University, has been a senior research associate at the Bigel Institute since 1980.