In order to maintain universal access to medically effective care for all, costs must be contained at both the system-wide and micro levels. The managed competition model offers a framework within which increased efficiency could be pursued without sacrificing the goal of universal access and without impairing health outcomes and social cohesion. It would do this by removing structural impedime...

There is evidence in California of a broad decline in health care costs to employment groups adopting managed care and managed competition--premium reductions up to 10 percent. National comparisons and utilization data generally confirm the beginning of lower costs. Large California medical groups and health systems have responded to pressure by finding ways to reduce costs and improve quality....

This article addresses three topics. First, it reports on the international interest in the health care reforms of Switzerland and The Netherlands in the 1990s and early 2000s that operate under the label "managed competition" or "consumer-driven health care." Second, the article reviews the behavior assumptions that make plausible the case for the model of "managed competition." Third, it anal...

Common sense and empirical evidence suggest that single-payer health insurance, combined with competitive private delivery, would be the most cost-effective way of achieving the major, widely accepted goals of health care reform. Among the current presidential candidates, Kucinich and Gravel have the most promising reform proposals, with Edwards's and Obama's as fall-backs.

A new approach to universal health insurance combining managed competition and global budgets promises to break the impasse blocking comprehensive health reform. The central innovation is the development of regional health insurance purchasing cooperatives (HIPCs) as managers and reorganizers of the market and platforms for global budgets. Financing would be based on community-rated premiums, w...

Competition among health plans, hospitals, and physicians has taken place in fifteen health care markets primarily on the basis of price and secondarily on network breadth and style of care. In most markets, competition resulted in lower (or slowly growing) premium prices. Within a type of plan product, competition was leading to similar prices and networks and was reducing product differentiat...

Matrices of correlation coefficients between the abundances or intensities of all pairs of helminth species, across all individual hosts in a sample, are regularly used to detect possible cases of interspecific competition in parasite communities. In these matrices, however, the range of possible values that any correlation coefficient can take is not -1 to 1, contrary to what is generally assu...

This article assesses the extent to which managed competition could be successful in rural areas. Using 1990 Medicare hospital patient origin data, over 8 million rural residents were found to live in areas potentially without provider choice. Almost all of these areas were served by providers who compete for other segments of their market. Restricting use of out-of-State providers would severe...

A market made up of health care financing and delivery plans and individual consumers, without a carefully drawn set of rules to mitigate market failures, and without mediation by collective action on the demand side, cannot produce efficiency and equity. The concept of competition that can achieve these goals, at least to a satisfactory approximation, is managed competition, with intelligent a...