Health maintenance organizations (1 - 10 of 61 items)
Private Health Insurance: Research on Competition in the Insurance Industry
GAO-09-864R: Published: Jul 31, 2009. Publicly Released: Aug 31, 2009.
Health care providers and members of Congress have raised concerns that consolidation in the private health insurance industry may be resulting in less competitive markets and contributing to rising health insurance rates paid by consumers and employers. However, measuring the extent of changes in market competition over time or the effects of changes is challenging. In particular, reliable, longi...
Federal Employees Health Benefits Program: Differences in Health Care Prices Across Metropolitan Areas Linked to Competition and Other Factors
GAO-06-281T: Published: Dec 2, 2005. Publicly Released: Dec 2, 2005.
Differences in utilization of health care services across the country have been well documented, but less has been reported on geographic variation in price. As health care spending is the product of utilization and price, information on health care prices and factors contributing to price differences provides an additional perspective on drivers of health care spending. In an August 2005 report,...
Federal Employees Health Benefits Program: Competition and Other Factors Linked to Wide Variation in Health Care Prices
GAO-05-856: Published: Aug 15, 2005. Publicly Released: Sep 14, 2005.
Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care sp...
Medicare and Medicaid: Implementing State Demonstrations for Dual Eligibles Has Proven Challenging
HEHS-00-94: Published: Aug 18, 2000. Publicly Released: Sep 18, 2000.
Pursuant to a congressional request, GAO reviewed states' initiatives to enroll dual eligibles (beneficiaries who qualify for both Medicare and Medicaid benefits) into one managed care plan, focusing on: (1) the status and key features of state initiatives focusing on: (1) the status and key features of state initiatives to integrate care for dual-eligible beneficiaries; and (2) factors that have...
Prescription Drugs: Expanding Access to Federal Prices Could Cause Other Price Changes
HEHS-00-118: Published: Aug 7, 2000. Publicly Released: Sep 6, 2000.
Pursuant to a congressional request, GAO provided information on the expansion of Medicare beneficiaries' access to prescription drugs, focusing on the: (1) federal drug price discounts available to federal and nonfederal purchasers and the size of those discounts; and (2) potential effects that extending such discounts to nonfederal purchasers may have on outpatient drug prices paid by federal an...
Medicare+Choice: Reforms Have Reduced, but Likely Not Eliminated, Excess Plan Payments
HEHS-99-144: Published: Jun 18, 1999. Publicly Released: Jun 22, 1999.
Pursuant to a congressional request, GAO reviewed concerns surrounding the Balanced Budget Act's (BBA) health plan payment changes, focusing on: (1) the extent to which health plans provide additional benefits and whether they could continue to provide additional benefits if payments were reduced; (2) the evidence regarding managed care's effect on Medicare spending; and (3) whether BBA provisions...
Private Health Insurance: Impact of Premium Increases on Number of Covered Individuals Is Uncertain
T-HEHS-99-147: Published: Jun 11, 1999. Publicly Released: Jun 11, 1999.
Pursuant to a congressional request, GAO discussed the impact of private health insurance premium increases on the number of covered individuals, focusing on: (1) the trends in employers' decisions to offer insurance and employees' decisions to purchase it; (2) an assessment of recent studies that have estimated the relationship between premium increases and insurance coverage; and (3) conditions...
Medicare Managed Care: Payment Rates, Local Fee-for-Service Spending, and Other Factors Affect Plans' Benefit Packages
HEHS-99-9R: Published: Oct 9, 1998. Publicly Released: Oct 9, 1998.
Pursuant to a congressional request, GAO provided information on Medicare's health maintenance organizations (HMO), focusing on: (1) the key differences between Medicare's traditional fee-for-service (FFS) and managed care programs; (2) how Medicare historically set the monthly capitation rates paid to managed care plans and why these rates varied among counties; (3) how the Balanced Budget Act of...
Private Health Insurance: Impact of Premium Increases on the Number of Covered Individuals Is Uncertain
HEHS-98-203R: Published: Jul 7, 1998. Publicly Released: Jul 31, 1998.
Pursuant to a congressional request, GAO provided information on the relationship between the amount charged for private health insurance and the number of insured individuals, and the basis for a widely cited statistic from the Lewin Group that the number of insured individuals would fall by 400,000 for every 1-percent increase in health insurance premiums, focusing on: (1) trends in employers' d...
Medicare: Fraud and Abuse Control Pose a Continuing Challenge
HEHS-98-215R: Published: Jul 15, 1998. Publicly Released: Jul 15, 1998.
Pursuant to a congressional request, GAO reviewed fraud and abuse in both Medicare's fee-for-service and managed care programs, focusing on: (1) the impact of inadequate program safeguard funding on efforts to combat improper Medicare payments; (2) ineffective management and oversight of fee-for-service payments and operations; and (3) ineffective oversight of Medicare managed care plans.GAO noted...