In 2012, the Medicare program paid private health plans $136 billion to cover about 13 million beneficiaries who received Part A and B benefits through the Medicare Advantage (MA) program rather than traditional fee-for-service (FFS) Medicare. Private plans have been a part of the program since the 1970s. Debate about the policy goals--Should they cost less per beneficiary than FFS Medicare? Sh...

OBJECTIVE The new contract for primary care in the UK offers fee-for-service (FFS) payments for a wide range of activities in a quality outcomes framework (QOF), with payments designed to reflect likely workload. This study aims to explore the link between these financial incentives and the likely population health gains. METHODS The study examines a subset of eight preventive interventions c...

Objectives. The purpose of this study was to investigate whether or not there is an association between managed care insurance and the delivery and outcome of care in patients presenting with unstable angina. Background. The proportion of U.S. patients with managed care health insurance is increasing. This may be associated with recent improvements in the control of health care costs. It is unk...

OBJECTIVE Use of physician service claims and other administrative data is increasingly being advocated for chronic disease surveillance. However, such data may be vulnerable to reimbursement policy changes. We sought to determine how non-fee-for-service (non-FFS) primary care affects the detection of diabetes using physician claims data. METHODS Ontarians over age 66 with diabetes and receiv...

BACKGROUND Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care. METHODS We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets an...

OBJECTIVES To compute a benchmark for tracking readmission rates among patients enrolled in Medicare's private comprehensive Medicare Advantage (MA) plans and to develop preliminary comparisons with the fee-for-service (FFS) readmission rates. STUDY DESIGN Descriptive data presentation with analytic discussion. METHODS We computed a benchmark for rehospitalization rates among MA patients us...

OBJECTIVES To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus. DESIGN Secondary data analyses of South Carolina (SC) Medicaid enrollees. PARTICIPANTS SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) pro...

OBJECTIVE To compare the clinical quality of care between Medicare fee-for-service (FFS) and Medicare Advantage (MA) programs. METHODS We compared 11 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures nationwide for MA managed care plans and the FFS program in 2006 and 2007. We adjusted FFS measures to match the geographic distribution of MA. RESULTS Medicare Advanta...

This paper analyzes and compares the incentive properties of some common payment mechanisms for GPs, namely fee for service (FFS), capitation and fundholding. It focuses on gatekeeping GPs and it specifically recognizes GPs heterogeneity in both ability and altruism. It also allows inappropriate care by GPs to lead to more serious illnesses. The results are as follows. Capitation is the payment...

Microeconomic theory predicts that if patients are fully insured and providers are paid fee-for-service, utilization of medical services exceeds the efficient level ('moral hazard effect'). In Switzerland, both demand-side and supply-side cost sharing have been introduced to mitigate this problem. Analyzing a panel dataset of about 160,000 adults, we find both types of cost sharing to be effect...