000			02861cam a22003377 4500
001			w10377
003			NBER
005			20211020112819.0
006			m o d
007			cr cnu||||||||
008			210910s2004 mau fo 000 0 eng d
100	1		_aDor, Avi.
245	1	0	_aTransaction Prices and Managed Care Discounting for Selected Medical Technologies: _bA Bargaining Approach / _cAvi Dor, Michael Grossman, Siran M.Koroukian.
260			_aCambridge, Mass. _bNational Bureau of Economic Research _c2004.
300			_a1 online resource: _billustrations (black and white);
490	1		_aNBER working paper series _vno. w10377
500			_aMarch 2004.
520	3		_aIt is generally assumed that managed care has been successful at capturing discounts from medical providers, but the implications have been a matter of debate. Critics argue that managed care organizations attain savings by reducing intensity of services, while others have argued that savings are 'real' and are a consequence of discounts per unit of care. To address this, we obtain separate transaction prices for hospital episodes (treatment) and for the narrowly defined surgical procedure, using the example of heart bypass surgery. Both sets of prices were drawn from a database of insurance claims of self-insured firms that offer a menu of insurance options. We use a Nash-Bargaining framework to obtain price discounts by type of insurance. Adjusting for product and patient heterogeneity, the per-procedure prices yield the anticipated pattern of discounts: Relative to traditional fee for service, point-of-service HMOs exhibited the largest discounts followed by Preferred-Provider-Organizations (18 and 12 percent, respectively). While reductions in intensity of services are not directly observable from the data, combining the results from the per-procedure and per-episode analysis yields a range of intensity reduction of 20-6 percent, with a corresponding per-unit price discount of 4-18 percent for the entire episode. We conclude that a large share cost savings by managed care organizations are due to per-unit price reductions.
530			_aHardcopy version available to institutional subscribers
538			_aSystem requirements: Adobe [Acrobat] Reader required for PDF files.
538			_aMode of access: World Wide Web.
588	0		_aPrint version record
690		7	_aJ11 - Demographic Trends, Macroeconomic Effects, and Forecasts _2Journal of Economic Literature class.
700	1		_aGrossman, Michael. _911927
700	1		_aM.Koroukian, Siran.
710	2		_aNational Bureau of Economic Research.
830		0	_aWorking Paper Series (National Bureau of Economic Research) _vno. w10377.
856	4	0	_uhttps://www.nber.org/papers/w10377
856			_yAcceso en línea al DOI _uhttp://dx.doi.org/10.3386/w10377
942			_2ddc _cW-PAPER
999			_c337793 _d296355