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Examines the relationship between the presence of financial incentives and their effect on physician behaviour in health maintenance organizations (HMOs). By reviewing the scope and dimensions of both HMOs and financial incentives, a foundation is laid for the review of the current empirical evidence. Further analysis and conceptual development is given to this topic by stating the limitations of existing research – in the confounding variables, in the complexity of incentives, and in the unanswered questions of quality of care – and by proposing innovative ways of studying the “other aspects of physician behaviour” not previously considered. Questions and implications are raised for future research and practice.

Estimates a total effects cost function using a national 1994 health maintenance organization (HMO) data set to examine and update findings related to HMO efficiency. The cost function controls for ownership characteristics (profit status and ownership), size, enrollment diversity, regional location, product diversity, model type, payment characteristics, and years of operation. While not explicitly controlling for quality or acuity, measures of plan and enrollee diversity help control for acuity and quality. Results show that most of the difference in cost efficiency between HMOs is explained by factors specific to the HMO, including efficiencies of scale and scope, lower levels of Medicare patients, and efficient levels of capital. The study also shows that for‐profits are more efficient than non‐profits because they rely less on withhold pools to control costs. Limitations of the study include weak controls for quality of care, and limited data related to payment characteristics.

Purpose – To examine the effects of health insurance types on the use of prescribed medication that treat patients with hypertension, diabetes, and asthma. The study distinguishes between individuals with private health maintenance organization (HMO) plans and private non-HMO plans. The study also distinguishes between people with health insurance and drug coverage and people with health insurance and no drug coverage.

Methods – Joint discrete factor models are estimated to control for endogeneity of each type of coverage.

Findings – The main findings suggest that the effect of health insurance varies across patients with different conditions. The strongest and most significant effect is evident among patients with hypertension while the weakest and least significant is among patients with asthma. These findings suggest that patients with asymptomatic conditions are more likely to exhibit moral hazard than patients with conditions that impose immediate impairment. Additional results suggest that, relative to the uninsured and people with health insurance but no drug coverage, patients with drug coverage are more likely to initiate drug therapy and to consume more medications.

Originality – The results of the study indicate that moral hazard of drug utilization is condition specific. The variation in “silence” of conditions’ symptoms could be a key reason for difference in insurance effects among patients with hypertension, diabetes, and asthma.

Pharmaceuticals are essential for the management of many chronic conditions. As a result, it is important to examine how the administration of pharmaceutical benefits affects physicians and pharmacists providing chronic care services. In the 1990s, HMOs and PPOs began to more aggressively manage outpatient pharmaceutical benefits, leading to the growth of pharmaceutical benefit management companies (PBMs).

In this exploratory study, 10 primary care physicians and 12 pharmacists in the San Francisco area were interviewed in 1999, and 11 more pharmacists in 2004, on how they worked with PBMs and their controls on prescribing and dispensing. Responses indicated major problems for both health professionals in negotiating with the PBM as a third party payor, in coping with switches and multiple formularies, and in added work for the health care professional. Increased risk to chronically ill patients for poorer outcomes is an important related problem with PBMs.

The Medicare drug benefit law passed in 2003 will likely result in similar problems for many beneficiaries, including those with chronic care needs. The paper proposes some policy solutions to reduce PBM problems for physicians, pharmacists and the Medicare population.

Tests the theory that owners (hospital, physician, insurance) of vertically integrated health maintenance organizations (HMOs) might substitute towards production of their own specialty goods. Uses data from various sources in the USA. Determines the impact of ownership on factors such as average physician ambulatory services per enrollee and average hospital days per enrollee. Concludes that policymakers need to encourage the development of standard publicly available quality measures to intensify competition and eliminate excess profits accruing to provider‐owners who substitute towards production of their own goods.

The spiraling cost of health care is emerging as one of the country's most urgent problems and a major domestic political issue. In the 1940s, prepaid medical care provided by groups of health‐care professionals began to take hold and finally emerged as a serious prospect for cost‐effective health care with the passage of the Health Maintenance Organization Act of 1973 (42 U.S.C. 300e). Although still not widespread, interest in HMOs is growing and government incentives to private investment in such organizations should prompt inquiries to libraries from citizens groups, businesspeople, and potential customers of these services. Here is a sampling of items on the subject.

The American health care system continues to be one of the nation′s greatest concerns. Expenditure on the system is rocketing because of new methods of delivering care plus the costs of new technology and so new methods must be found to make the system more cost effective and efficient.

To apply path dependence theory and analysis to the regulatory framework for private-rented housing in Britain, especially affecting houses in multiple occupation (HMOs) and addressing the increased involvement of the planning system through planning use classes, permitted development rights and Article 4 directions.

This paper identifies critical junctures in primary and secondary legislation for housing and planning and analyses individual local authority responses in planning policy documents and tribunal decisions.

The rise of the HMO reflects wider changes in society leading to new forms of household and inter-generational inequalities. Local authority discretion and locked-in responses have resulted in different regulatory regimes for housing and planning, recently favouring existing communities of owner-occupiers against HMO residents, seen as transient populations not committed to the neighbourhood.

Potential for further research on demographics and household formation, and on reviewing planning and appeal decisions involving HMOs.

The research is apparently the first specifically addressing planning regulation of the HMO from a path dependence perspective, in the context of planning protection of the single-family dwelling house and marginalization of other forms of housing.

This chapter investigates whether signing more hospital contracts with Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), hospital affiliation in a system, having more system hospital members located in the same area, and increased competition from area hospitals, contributes to improvements in the cost efficiency of U.S. Midwestern hospitals. Hospitals may offer HMOs and PPOs discounts on contracts to provide health care services to firm employees enrolled in HMOs and PPOs (discounts would lead to smaller price mark-ups over costs for hospital services). Enacting policies to enhance cost efficiency may help hospitals maintain a specified level of profits.

The purpose of this paper is to suggest the fuzzy quality function deployment (QFD) method to assess LIFENET customers' spoken and unspoken needs in order to achieve the various objectives like: how to decide optimum portfolio for health services strategically; how to assess competitors' market position in order to reckon the market position of LIFENET; and how to set the revised target in order to satisfy the customers' demand and to fetch profit in order to satisfy managers' mission and vision in a competitive market.

A fuzzy QFD method has been devised to take care of the various LIFENET objectives. Fuzzy logic's use has been recommended to remove the uncertainty, vagueness, and impreciseness from data obtained to assess customers' spoken and unspoken needs. Symmetric triangular fuzzy numbers (STFNs) may be used to assess various needs to enhance data accuracy. House of quality (HOQ), an in‐built QFD matrix, may be constructed to take care of LIFENET's various requirements in order to satisfy internal and external customers.

Fuzzy QFD plays a vital role in assessing customers' need in terms of WHATs. Various WHATs thus obtained can be accomplished by incorporating technical parameter HOWs'. The QFD HOQ offers various vital comparisons for instance, WHATs vs HOWs, HOWs vs HOWs, NOWs vs WHATs, etc. to obtain important inferences, which help to revise target to remain competitive in the market. Fuzzy QFD helps devise a management strategy to follow customers' needs in health industry successfully.

Accessing Indian customers' needs poses many challenges as the decision to opt for a given healthcare service is most uncertain because it varies from person to person. The set of parameters that influence individual decisions to opt for healthcare services are costs, treatment response time, disease/risk, and health service satisfaction. Fuzzy QFD may help LIFENET promoters to consider customers' favored health services thereby helping strategically in their attempt for major expansion, in order to get the most benefits of becoming first‐movers in the sector. Fuzzy QFD may also help LIFENET to avert major investment decisions that looked attractive in short‐term, but in fact were unfruitful, in long‐term.