Broadhead P; AcademyHealth. Meeting (2003 : Nashville, Tenn.).

Abstr AcademyHealth Meet. 2003; 20: abstract no. 354.

University of California San Francisco, Institute for Health Policy Studies, 3333 California Street - Suite 265, San Francisco, CA 94118 Tel. (415) 502-4559 Fax (415) 476-0705

RESEARCH OBJECTIVE: To propose a more rigorous conceptual framework to support analysis of the mechanisms used by health plans to influence the health care providers' practices and consumers' use of health care. STUDY DESIGN: This is a methodological paper rather than an empirical study. Approach has been to review literature and develop analytical framework. POPULATION STUDIED: N/A PRINCIPAL FINDINGS: Cogent arguments have been made that there is a lack of rigour in the terminology and analytical categories used to distinguish types of health cover in much of the health services reasearch literature. Terms such as managed care are often not explicitly defined, and are used differently in different articles and sometimes at different points in the same article. Reliance in academic literature on common use terms and marketing labels such 'staff HMO', 'network HMO', 'PPO', 'POS plan', 'EPO' and so on, undermine meaningful analysis. Past proposals for a more rigorous approach have shared some of the problems raised or have not been sufficiently developed to be practically useful. This paper proposes a generalised analytical framework based on differentiating the types of relations between health plans and providers and the extent and nature of the methods used by plans to influence providers' practices and consumers' use of health care. CONCLUSIONS: Academic analyses and writing on health plans, managed care and related matters wwould benfit from the adoption of a more rigorous conceptual framework for understanding and chrarcterising the relations between health plans and providers and the mechanisms used by health plans to influence providers' practices and consumers use of health care. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Has implications for the use of terminology and conceptual categories in a wide range of academic literature commenting on health cover, and the mechanisms of managed care, including the use of financial and other incentives to influence provider and consumer behaviour.

Publication Types:

• Meeting Abstracts

Keywords:

• Delivery of Health Care
• Health Maintenance Organizations
• Health Planning
• Health Services
• Managed Care Programs
• Preferred Provider Organizations
• economics
• utilization
• hsrmtgs

Other ID:

• GWHSR0004220

UI: 102275905

From Meeting Abstracts