Managed Care as a Public Cost-Containment Mechanism
利用美国军事医疗系统的示范项目数据，分析管理式医疗改革对医疗服务利用的影响，发现HMO的慷慨福利增加了门诊需求，而严格的利用率审查并未显著缩短住院时间，质疑了依赖大型管理式医疗网络控制公共医疗成本的有效性。
This article identifies the impact of managed-care reforms on the utilization of medical services within the military health-services system. The data come from a recent demonstration project that substituted an HMO and PPO for traditional FFS arrangements. Results from a semiparametric model indicate that the generosity of benefits in the HMO increased demand for ambulatory services. Unlike the private-sector experience with managed care, aggressive utilization review did not significantly curtail inpatient stays. These results vitiate the presumed effectiveness of reform strategies that rely on large, geographically diffused managed-care networks to contain public-sector health costs.