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Media Advisory Date: November 10, 1997
New studies supported by the Agency for Health Care Policy
and Research (AHCPR) and published in today's issue of the
journal, Health Affairs, present the first comprehensive look at
what is currently happening in the health care marketplace.
The articles form an invaluable evidence-based core of
information for current discussions of policy options by all
health care system participants—both public and private.
"The role of AHCPR is not simply to describe the health care
world, but to disseminate information that will help those who
seek to improve it," said John M. Eisenberg, M.D., M.B.A.,
AHCPR's administrator. "These articles provide fundamental
knowledge about the link between the financing and delivery of
health care and the quality of services."
AHCPR's studies empirically and rigorously examine issues of
how current, incentive-driven market decisions of multiple
participants—hospitals, physicians, health plans, employers,
employees, and public, private and individual purchasers—determine who gets health care, what kind of care, how much care,
who pays and how much.
A brief look at the AHCPR studies shows that:
- In Segmentation of Hospital Markets: Where Do HMO
Enrollees Get Care?, José J. Escarce and colleagues
suggest that HMOs may not systematically channel their
enrollees to high-volume, low-mortality hospitals.
- In Which Types of Hospital Mergers Save Consumers
Money?, Robert A. Connor and colleagues find that,
overall, horizontal mergers benefit consumers but more
antitrust scrutiny is needed.
- Jan P. Clement and others in Strategic Hospital
Alliances: Impact on Financial Performance, find that
when hospitals form strategic alliances, their revenues
increase but their costs do not.
- Lawton R. Burns and colleagues question prevailing
tools used for analyzing market evolution in Managed
Care, Market Stages, and Integrated Delivery Systems:
Is There a Relationship? Their findings indicate that
these tools seem better at producing a snapshot of
markets rather than distinguishing sequential stages of
- In The Provision of Primary Care: Does Managed Care
Make a Difference?, Carol J. Simon and co-researchers
find that in response to managed care, physicians have
been specializing more, and this is linked to their
involvement in managed care.
- In Effects of HMO Penetration on Physicians' Work
Effort and Satisfaction, Jack Hadley and Jean M.
Mitchell document the extent and nature of physicians'
reservations about how they now practice medicine.
- In HMO Market Structure and Performance: 1985-1995,
Douglas R. Wholey and colleagues take a comprehensive
look at a decade of managed care data and find evidence
confirming the widely held perception that hospital
days are declining among HMO patients, while use of
ambulatory care is up. Their analysis not only
documents the role of plan competition but also
provides a closer look at the differential patterns of
competition for different kinds of managed care
- William M. Sage points out in Judge Posner's RFP:
Antitrust Law and Managed Care, that the dearth of
empirical data on competition in the managed care
market leads to theoretical guesses in our courts of
law. His paper calls for sound empirical information
that can be used in the formulation, appropriate
enforcement, and litigation of antitrust law.
- David Colby points out in his paper, Doctors and Their
Discontents, that despite dramatic changes in
physicians' autonomy, medicine continues to be an
- Michael H. Bailit argues in A Purchaser's View of
Health Care Market Trends, that a decline in competition
and few rewards for higher-quality care threaten the
health of the managed care marketplace.
- Finally, AHCPR researchers Philip F. Cooper and Barbara
Steinberg Schone find in More Offers, Fewer Takers for
Employment-Based Health Insurance: 1987 and 1996, that
as many as six million Americans are not choosing to
accept health insurance even when offered it. The
study found that the number of workers declining
employment-based health increased by 140 percent
between 1987 and 1996. Those most likely to turn down
insurance are young (under age 25), single, Hispanic or
black, and work for low wages. Possible factors
driving this trend include the decline in real wages,
higher employee contribution rates, and state
legislation aimed at enhancing insurance coverage which
may have increased costs. The study was based on data
from AHCPR's new Medical Expenditure Panel Survey and
its 1987 National Medical Expenditure Survey.
Health Affairs is the health policy
journal published by Project HOPE, 7500 Old Georgetown Road,
Suite 600, Bethesda, MD 20814-6133; (301) 656-7401.
For additional information, contact AHCPR Public Affairs:
Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov) or
Salina Prasad (SPrasad@ahrq.gov).