The Managed Care Backlash: Did Consumers Vote with Their Feet?

The managed care backlash led many to predict the demise of health maintenance organizations (HMOs). This paper examines trends in HMO enrollment in all metropolitan communities from 1994 to 2000 to identify factors that led to diminishing enrollment in the backlash era and circumstances in which HM...

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Bibliographic Details
Published inInquiry (Chicago) Vol. 41; no. 4; pp. 376 - 390
Main Authors Marquis, M. Susan, Rogowski, Jeannette A., Escarce, José J.
Format Journal Article
LanguageEnglish
Published Los Angeles, CA Excellus Health Plan, Inc 01.12.2004
SAGE Publications
SAGE PUBLICATIONS, INC
SAGE Publishing
Subjects
Adult
Adverse selection
Age
Aged
Capitation
Catchment Area (Health)
Consumer Behavior
Consumers
Cost control
Employers
Enrollments
Health care costs
Health care policy
Health insurance
Health maintenance organizations
Health Maintenance Organizations - economics
Health Maintenance Organizations - trends
Health Maintenance Organizations - utilization
HMOs
Humans
Managed care
Market penetration
Medicaid
Medical sector
Medicare
Metropolitan areas
Middle Aged
Multivariate Analysis
Physicians
Population characteristics
Population dynamics
Private Sector
Regression Analysis
Studies
Trends
United States
Urban Health Services - economics
Urban Health Services - trends
United States
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Summary:The managed care backlash led many to predict the demise of health maintenance organizations (HMOs). This paper examines trends in HMO enrollment in all metropolitan communities from 1994 to 2000 to identify factors that led to diminishing enrollment in the backlash era and circumstances in which HMOs maintained or expanded their presence. We use a database constructed from a wide variety of sources that describe HMO penetration and other characteristics of all metropolitan statistical areas. We found the backlash is not evidenced in a large degree of consumer switching. However, HMOs were more likely to maintain their presence in areas with high-cost growth and with greater managed care experience. Medicaid HMO growth continued to expand rapidly, indicating the possibility of a two-tiered system in which low-income beneficiaries have less choice than the privately insured.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ISSN:0046-9580
1945-7243
DOI:10.5034/inquiryjrnl_41.4.376