This paper examines four propositions inherent in competitive approaches to containing the growth of health care expenditures: (1) that health maintenance organizations can deliver health care less expensively than the fee-for-service system; (2) that under certain competitive conditions. HMOs would prosper; (3) that HMO successes would force FFS insurers and providers to become more efficient; and (4) that creating the competitive conditions would be politically feasible. Reasons for doubting the latter three propositions are plentiful, and the strategy is therefore judged unlikely to succeed.
Carl G. Homer; Some Pitfalls in Creating Competition between Hmos and Fee-for-Service Delivery. J Health Polit Policy Law 1 June 1982; 7 (3): 686–706. doi: https://doi.org/10.1215/03616878-7-3-686
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