Characteristics of health maintenance organizations and their influence on efficiency.

This study examines the efficiency of Health Maintenance Organizations (HMOs) based on a sample of 249 HMOs operating in the United States in 1995. Data Envelopment Analysis (DEA) was used to calculate the level of technical efficiency for each HMO included in the sample. Further descriptive analyses were conducted examining various structural and operational characteristics of HMOs and their impact on efficiency. Federal qualification status, Medicare programme participation, combined Medicare and Medicaid programmes participation, chain affiliation and size were found to be significant influences on HMO efficiency.

Revisiting employee benefits managers.

This article presents a case study of health purchasing practices of a sample of Employee Benefits Managers (EBMs) in a medium-size metropolitan area who were interviewed in 1991 and again in 1998. Findings show that employers have become less paternalistic in their health benefits; shifted plan options from indemnity coverage to managed care; increased employee cost-sharing; and placed greater decision-making on employees. EBMs embrace choice in health plans, have influenced the provider networks of plans, and have specified requirements for plan performance, however, use of quality information is limited.

Changing dynamics in employer-sponsored health insurance. One market's perspective.

Using their sponsored health benefits as a mechanism for change, employers have been able to exert significant influence over the nation's health care system. By examining how employers design, purchase and manage these programs, much insight can be gained. Twenty-five mid- to large-sized companies in a Middle-Atlantic metropolitan area were interviewed during May-July 1998. The study was modeled after a similar effort conducted in 1991, the results of which were published in this journal in 1993. The study found that many of the dynamics in employer-sponsored health insurance are changing. The findings suggest that a more distanced relationship between employers and employees is the major factor underlying the evolution, an intentional change to force a shift in medical care decision-making and responsibility to more of a shared process between the employee and the employer. These trends have important implications for local markets relevance and the national situation.

Reversal of fortune: commercial HMOs in the Medicaid market.

Between 1992 and 1996 the number of health maintenance organizations (HMOs) entering the Medicaid market grew at an average annual rate of approximately 22 percent. Participation among all ownership segments grew, resulting in a broad distribution of beneficiaries across the HMO industry. However, recent declines in financial performance within the industry appear to be more dramatic for plans with many Medicaid members. In addition, growing concerns about rate adequacy and volatility as well as expanding administrative demands raise questions about the long-term commitment of commercial HMOs to Medicaid participation. This paper analyzes operating characteristics and financial performance of licensed commercial HMOs from 1992 through 1996, drawing on indepth interviews with health plan executives and managed care stock analysts.

Neonatal necrotizing enterocolitis. Occurrence secondary to thrombosis of abdominal aorta following umbilical arterial catheterization.

A patient had neonatal necrotizing enterocolitis (NNE), secondary to aortic thrombosis following umbilical arterial catheterization. The thrombus occluded the ostium of the inferior mesenteric artery. A review of cases reported in the literature with complications following umbilical arterial catheterization revealed four instances of NNE or NNE-like lesions due to thrombosis of the abdominal aorta or one of its major branches. Thrombosis of the aorta, with occlusion of one or more of its major abdominal branches following umbilical arterial catheterization, should be considered as a potential etiologic factor in certain cases of NNE.