Feldman R, Kralewski J, Dowd B
Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455.
Health Serv Res. 1989 Jun;24(2):191-211.
This article describes the changes taking place in a mature HMO market that has been identified as a bellwether HMO community, the Minneapolis-St. Paul metropolitan area. We describe how this market--previously characterized by traditional HMOs and traditional fee-for-service plans--has been transformed within the past five years into a market with a variety of plans competing on the dimensions of premiums, provider choice, and coverage. Among the most significant changes are the evolution of the local Blue Cross and Blue Shield plan into a form resembling an individual practice arrangement (IPA) with broad coverage and broad provider choice, and the appearance of preferred provider plans sponsored by the HMOs. We suggest that such changes have blurred the distinction between health plan types, making traditional plan designations no longer valid for either health policy analysis or health services research. For example, studies contrasting the performance of HMOs and fee-for-service plans should concentrate instead on the various dimensions of these plans, such as coverage and openness of provider choice. The article is intended to stimulate discussion and to suggest a new framework for describing health plan competition.
本文描述了在一个成熟的健康维护组织（HMO）市场中发生的变化，该市场已被认定为一个具有风向标意义的HMO社区，即明尼阿波利斯-圣保罗都会区。我们阐述了这个以前以传统HMO和传统按服务收费计划为特征的市场，是如何在过去五年中转变为一个在保费、提供者选择和保险范围等方面存在多种计划相互竞争的市场。其中最显著的变化包括当地蓝十字蓝盾计划演变成一种类似于个体行医协会（IPA）的形式，具有广泛的保险范围和广泛的提供者选择，以及HMO赞助的优选提供者计划的出现。我们认为，这些变化模糊了健康计划类型之间的区别，使得传统的计划类别对于健康政策分析或健康服务研究而言都不再有效。例如，对比HMO和按服务收费计划绩效的研究，应转而关注这些计划的各个方面，如保险范围和提供者选择的开放性。本文旨在激发讨论，并提出一个描述健康计划竞争的新框架。
