Strumwasser I, Paranjpe N V, Ronis D L, McGinnis J, Kee D W, Hall H L
Michigan Health Care Education and Research Foundation, Detroit 48226.
Inquiry. 1989 Winter;26(4):432-41.
Health care costs and utilization by salaried employees and their dependents at a large self-insured midwestern industrial manufacturing corporation were analyzed for the year before employees were first offered a triple option choice. Members had the option of retaining traditional Blue Cross and Blue Shield of Michigan (BCBSM) coverage or switching to either a number of health maintenance organizations (HMOs) or a number of preferred provider organizations (PPOs). Members who switched to HMOs or PPOs were generally younger and had lower average expenses and utilization rates than those who retained the traditional BCBSM plan. The results suggest that a selection bias does occur in this population, as lower cost members were more attracted to the HMOs and PPOs than were more expensive members. Implications for the corporation as well as for the drive toward managed care alternatives are discussed.
在一家大型的中西部工业制造企业首次为员工提供三种选择方案的前一年，对该企业受薪员工及其家属的医疗保健成本和使用情况进行了分析。员工可以选择继续保留传统的密歇根蓝十字蓝盾保险（BCBSM），或者转而加入一些健康维护组织（HMO）或一些优先提供者组织（PPO）。转而加入HMO或PPO的员工通常更年轻，平均费用和使用率低于保留传统BCBSM计划的员工。结果表明，在这一人群中确实存在选择偏差，因为成本较低的员工比成本较高的员工更倾向于加入HMO和PPO。本文还讨论了这一结果对该企业以及向管理式医疗替代方案发展的影响。
