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  • Title: Policy implications of risk selection in Medicare HMOs: is the federal payment rate too high?
    Journal: Issue Brief Cent Stud Health Syst Change; 1996 Nov; (4):1-7. PubMed ID: 10539724.
    Abstract:
    For more than a decade, Medicare beneficiaries have had the option to enroll in risk-contract health maintenance organizations (HMOs) in which the federal payment is set at 95 percent of the estimated fee-for-service cost. Two questions have been raised by health policy researchers ever since: Are Medicare HMO enrollees healthier than the elderly who receive fee-for-service care? If so, does the government payment rate for Medicare HMOs accurately reflect the costs that would have been incurred by a healthier population? This Issue Brief discusses three recent studies of the extent to which risk-contract HMOs experience biased selection and the cost of this to Medicare.
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