Health Maintenance Organization Rate-Setting Issues

HRD-89-46: Published: Jan 31, 1989. Publicly Released: Jan 31, 1989.

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Pursuant to a legislative requirement, GAO provided an overview of the data and methodology for computing Medicare monthly capitation payments to risk-contract health maintenance organizations (HMO).

GAO planned to meet its statutory mandate by discussing selected issues relating to the implementation of the current rate-setting methodology, problems with various aspects of rate-setting, and possible alternative approaches to Medicare HMO rate-setting.

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