Medical Insurance Trends

The PRM divides the United States population into four mutually exclusive insurance groups: ^[12]

(1) Insured under a fee-for-service arrangement;

(2) Insured in an exclusive network HMO (e.g., group-, staff-, network-, or mixed-model HMO);

(3) Insured under a different type of managed care plan (e.g., preferred provider organization [PPO], point of service [POS] organized as open-ended HMO, non-HMO POS, and other HMO/managed care plans); and

(4) Uninsured.

In the baseline scenario, we assume a constant insurance probability for each population group defined by age and sex using the year 2000 insurance distribution.

Based on use patterns determined through an analysis of the NIS, NHAMCS, NAMCS, NNHS and other sources, we estimated how per capita use of physician services compares under these four insurance types after controlling for population age and sex (Exhibit 23). For example, individuals in an exclusive network HMO use 86 percent as many anesthesiology services as individuals in a plan modeled after a traditional fee-for-service arrangement (controlling for age and sex). Individuals insured under other types of managed care plans and uninsured individuals use 98 percent and 29 percent as many anesthesiologist services, respectively, as individuals insured under the fee-for-service type plan.

Exhibit 23. Per Capita Use of Physician Services

(as a percentage of per capita use under an insured, fee-for-service arrangement)