Decline in Hospital Utilization and Cost Inflation Under Managed Care in California
JAMAPublished 2 October 1996Open access
James C. Robinson
Citations137
SJR quartileQ1
SJR score5.35
SNIP10.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Managed care is shifting the acute hospital from the center toward the periphery of the health care system through the substitution of outpatient for inpatient surgery, the shift from acute to subacute inpatient days, and the reduction of psychiatric hospitalization.
Abstract
Managed care is shifting the acute hospital from the center toward the periphery of the health care system.
Keywords
Economics, Econometrics and FinanceHealth Professions
The American Historical ReviewThe Social Transformation of American Medicine
3,287 Citations1984Judith Walzer Leavitt, Paul Starr
New England Journal of MedicineA Controlled Trial of the Effect of a Prepaid Group Practice on Use of Services
589 Citations1984Willard G. Manning, Arleen Leibowitz +3 more
The lower rate of use that the authors observed, along with comparable reductions found in non-controlled studies by others, suggests that the style of medicine at prepaid group practices is markedly less "hospital-intensive" and, consequently, less expensive.
JAMAManaged Care Plan Performance Since 1980
584 Citations1994Robert H. Miller
The evidence does not support the hypothesis that prepaid group practice or staff model health Maintenance organizations are more effective than individual practice association or network model health maintenance organizations.
Annals of Internal MedicineThe Care of Strangers: The Rise of America's Hospital System.
327 Citations1991Charles E. Rosenberg
New England Journal of MedicineHow Do Health-Maintenance Organizations Achieve Their “Savings”?
301 Citations1978Harold S. Luft
The Bell Journal of EconomicsThe Effects of Competition and Regulation on Hospital Bed Supply and the Reservation Quality of the Hospital
290 Citations1980Paul L. Joskow
A simple queuing model is used to examine several factors that affect hospital bed supply decisions and the reservation quality of the hospital and indicates that hospital reserve margins vary directly with the extent of interhospital competition and inversely with the intensity of hospital regulation.
JAMAVariations in Resource Utilization Among Medical Specialties and Systems of Care
285 Citations1992Sheldon Greenfield
Although variations in patient mix should be a major determinant of variations in resource use, the independent effects of specialty training, payment system, and practice organization on utilization rates need further explication.
Health AffairsVertical Integration and Organizational Networks in Health Care
277 Citations1996James C. Robinson, Lawrence P. Casalino
This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care and evaluates the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration", based on contractual networks.
Annals of Internal MedicineIn Sickness and In Wealth: American Hospitals in the Twentieth Century.
217 Citations1991
PubMedMedicare's prospective payment system: A critical appraisal.
187 Citations1991Robert F. Coulam, Gary Gaumer
The literature suggests that most of the intended effects of PPS on costs and intensity of care have been realized, but the literature fails to answer fundamental questions about the effectiveness and equity of administered pricing as a policy tool for cost containment.
Annual Review of Public HealthVariations in Resource Utilization Among Medical Specialties and Systems of Care
181 Citations1995Richard L. Kravitz, Sheldon Greenfield
The evidence that physician specialty training, the organization of physicians, and the method of physician payment are significant influences upon the utilization of health care services is reviewed.
Annals of Internal MedicineManaged Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization?
172 Citations1995Eve A. Kerr, Brian S. Mittman +4 more
Examination of internally imposed utilization management techniques used by 94 physician groups in California caring for more than 2.9 million capitated patients finds that physicians practicing in capitated groups are implementing utilization management policies that go beyond gatekeeping.
New England Journal of MedicineHospital Cost Containment in the 1980s
162 Citations1991William B. Schwartz, Daniel N. Mendelson
The era of easy reductions in the number of inpatient days, with the associated attenuation of rising costs, is largely over, and real hospital costs can be expected to rise, unless other effective measures to contain costs are implemented.
JAMACompetition and the Cost of Hospital Care, 1972 to 1982
153 Citations1987James C. Robinson
Findings on the cost implications of nonprice competition among hospitals suggest that the new modes of hospital payment will have a greater disruptive impact on hospital behavior in areas with many, rather than few, hospitals.
PubMedThe role of specialized clinical services in competition among hospitals.
153 Citations1986Harold S. Luft, James C. Robinson +3 more
It is found that the presence of nearby institutions and services increases the availability of most of these services in neighboring hospitals, which supports the hypothesis that competition among hospitals within an open-ended reimbursement environment takes the form of nonprice competition for community-based physicians through the acquisition of expensive clinical facilities.
New England Journal of MedicineThe Growth of Medical Groups Paid through Capitation in California
151 Citations1995James C. Robinson, Lawrence P. Casalino
Large medical groups paid through capitation in California offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs and the subcontractor status offering by H MOs that negotiate directly with individual physicians.
JAMAHospital Behavior Under Competition and Cost-Containment Policies
115 Citations1988Glenn Melnick
It is concluded that California's pro-competition policies are having dramatic and potentially far-reaching effects on the nature of hospital competition, leading to increased competition based on price.
JAMACompetition, Regulation, and Hospital Costs, 1982 to 1986
112 Citations1988James C. Robinson
Evaluating the relative effectiveness of regulatory and market-oriented cost-control policies on hospital cost inflation between 1982 and 1986 found that New Jersey began and ended the period from 1982 to 1986 with the lowest costs, controlling for wages and patient mix.
JAMAHMO Market Penetration and Hospital Cost Inflation in California
105 Citations1991James C. Robinson
Price competition between HMOs and conventional health insurers can significantly reduce hospital cost inflation if legislative barriers to selective contracting are removed.
New England Journal of MedicineMarket and Regulatory Influences on the Availability of Coronary Angioplasty and Bypass Surgery in U.S. Hospitals
65 Citations1987James C. Robinson, Deborah W. Garnick +1 more
Competition encouraged and regulation discouraged the proliferation of these cardiac services in the period under consideration, with the greatest regulatory effects being observed in the most competitive hospital markets.
Milbank QuarterlyThe Changing Boundaries of the American Hospital
51 Citations1994James C. Robinson
Transactions cost economics is used to analyze the changing boundaries of the hospital organization, particularly with respect to outpatient diagnostic and surgical clinics, home health agencies, and long-term-care facilities.
JAMACompetition and the Cost of Hospital Care
51 Citations1987Charles D. Weller
Robinson and Luft's basic error is fundamental: in effect, they turn competitive analysis of health care on its head by labeling as "competitive" what has long been known to make hospital marketsnoncompetitive under elementary economic theory—a virtual absence of price competition.
Journal of Health Politics Policy and LawCrabs in a Bucket: The Politics of Health Care Reform in California
31 Citations1984Linda A. Bergthold
The article focuses on the alteration of power relationships occasioned by the emergence of business interests as an active force in the formulation of health policy.
The Journal of Law and EconomicsAdministered Pricing and Vertical Integration in the Hospital Industry
26 Citations1996James C. Robinson
The "prospective payment system," implemented in 1983, created strong incentives for hospitals to reduce costs per admission by shortening the average length of patient stays, which created a new dependency of hospitals on nursing homes.
JAMACompetition, Regulation, and Hospital Cost
15 Citations1989Danuta Mendelson
To the Editor: A recent article by Drs Robinson and Luft 1 shows that the increase in hospital costs per adjusted admission in Massachusetts from 1982 through 1986 was 16.3% lower than that observed in 43 control states.