Who chooses service providers? The spread of consumer choice, 1992-2004.

Self-determination has been a dominant theme in the movement for the enhancement of the lives of adults with developmental disabilities, but who actually chooses the careproviders funded by state and federal dollars? Officials from all 50 states were interviewed to ascertain who chose the careprovider for youth transitioning from educational to adult services for each year from 1992 to 2004. The choices fell into roughly three levels: state-dictated, restricted individual choice, and unlimited individual choice. The highest level of choice offered in that state for a given year was tracked. The change in level of choice has been dramatic. In 1992, government dictated all careproviders in 42 states; by 2004, this was reduced to 9 states.

[Free choice of doctors in Germany in retrospect]. / Freie Arztwahl in Deutschland - eine historische Perspektive.

Due to discussions on the cost and quality of health care and a new legislation on the German statutory sickness insurance system in 1999, the free choice of doctors has recently become topical. To assess its legitimation for the German health care system, its history and the groups of interest involved should be taken into consideration. Before the period of industrialization no homogeneous pattern of the medical profession existed. In case of illness individuals who lived within reach and were known for their competence in disease matters were approached. However, industrialization destroyed existing social networks, and establishment of new structures of health care in rural as well as metropolitan areas became necessary. The government approached this challenge by structuring medical education, passing regulations on the settlement of doctors and promoting the foundation of statutory sickness funds. The Health Insurance Law of 1883 established a mandatory insurance system for a broad array of industries. As it was the sickness funds' responsibility to provide sufficient resources for medical care, a sick member was tied to the physician under contract with his insurance. After a rapid increase in practising physicians at the end of the 19(th) century, doctors' organisations were eager to gain access to the new market segment of insurance members by calling for the free choice of physicians. The Leipzig association (Hartmannbund) was founded in 1900 to organize strikes of doctors in order to get their goals accepted. After 30 years of conflicts an appeasement was achieved by a presidential emergency law in 1931. It transferred the responsibility for the provision of sufficient health care resources from the sickness funds to the newly created body of the Association of Sickness Fund Physicians (Kassenärztliche Vereinigung) and determined the patients' free choice among licensed sickness fund physicians.

Finance issue brief: any willing provider.

Today, almost half the states have laws obligating managed care organizations (MCOs) such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs) to contract with any willing health care provider. Although most provisions are limited to pharmacies or pharmacists, several states have adopted broad provisions applying to hospitals, physicians, chiropractors, pharmacists, podiatrists, therapists and nurses.

Finance issue brief: point of service.

A point-of-service (POS) option is a type of plan offered by managed care organizations (MCOs), including health maintenance organizations (HMOs), that allows people who are willing to pay higher out-of-pocket costs to see out-of-plan providers. Mandating a point-of-service option essentially eliminates the use of closed-panel HMOs. This issue brief addresses only bills that mandate managed care plans to offer a point-of-service option.