Favorable selection in the Medicare+Choice program: new evidence.

Historically, studying the Medicare managed care favorable-selection issue has been difficult because direct data on managed care enrollees have been unavailable. In this study, we analyzed the first year of Balanced Budget Act (BBA)-mandated inpatient encounter data. Based on this comparison of actual managed care and fee-for-service (FFS) beneficiaries, it appears that there are significant differences between these populations. The most striking differences are found in the comparison of average risk factors, indicating a clear bias in the managed care populations toward beneficiaries predicted to be less costly.

Risk Adjustment for the Medicare program: lessons learned from research and demonstrations.

The Balanced Budget Act (BBA) of 1997 requires numerous changes in Medicare. Medicare's managed care program has been reinvented as "Medicare + Choice," offering an expanded range of delivery system options for beneficiaries and a schedule of payment changes that will dramatically affect managed care plans. Preceding some of these BBA-legislated changes to Medicare were years of research and demonstrations. Risk-adjusted payment in the Medicare + Choice program, which is mandated for implementation in 2000, is one example of a longstanding developmental initiative. This paper provides a brief overview of risk adjustment-related research and demonstration activities carried out by the Health Care Financing Administration (HCFA) since the 1980s, and describes a possible technical approach for the implementation of risk-adjusted Medicare managed care payments in 2000.

Health system performance in OECD countries, 1980-1992. Organization for Economic Cooperation and Development.

U.S. health expenditure levels and rates of increase continue to exceed those of other Western industrialized nations. The pluralistic U.S. health care system has the highest excess health care inflation and opportunity costs of forgone nonhealth consumption and investment when compared with other major industrialized countries. While poor U.S. performance in terms of life expectancy at birth and infant mortality may partially result from social problems, there is little quantifiable evidence of value for money or equity in terms of health system performance.

Health spending, delivery, and outcomes in OECD countries.

Data comparing health expenditures in twenty-four industrialized nations show that the United States continues to lead the world in health spending as a percentage of gross domestic product. In 1991 the United States spent $2,868 per person on health care, compared with an average of $1,305 in Organization for Economic Cooperation and Development (OECD) countries. The U.S. figure exceeds spending in Canada, the next-highest spender, by 50 percent. Measures of health care use and health status do not provide convincing evidence that the United States has a superior health care system for its larger expenditure levels.

U.S. health expenditure performance: an international comparison and data update.

In this article, the authors present the most recently available data on the health care financing and delivery systems of the 24 industrialized member countries of the Organization for Economic Cooperation and Development (OECD). U.S. health expenditure performance is compared with the performance of other OECD countries. Thirty-six tables of data from 1960-90 are presented on health expenditures, health care prices, availability and utilization of health care services, health outcomes, and basic economic and demographic factors.