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Provider Selection, Bargaining, and Utilization Management in Managed Care
Author(s) -
Lindrooth Richard C.,
Norton Edward C.,
Dickey Barbara
Publication year - 2002
Publication title -
economic inquiry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 72
eISSN - 1465-7295
pISSN - 0095-2583
DOI - 10.1093/ei/40.3.348
Subject(s) - utilization management , selection (genetic algorithm) , managed care , business , economics , welfare , health care , public economics , operations management , actuarial science , computer science , economic growth , market economy , artificial intelligence
Managed care controls cost through a combination of provider selection, bargaining, and utilization management. Provider selection will reduce expenditures if patients are funneled to efficient providers. Bargaining will reduce expenditures through lower rates. Utilization management will reduce expenditures if providers reduce treatment intensity due to monitoring. We estimate that about 30% of the reduction in inpatient expenditures in a mental health carve‐out was due to provider selection, 5% was due to bargaining, and the remaining 65% was due to utilization management. We find that both the provider selection and utilization management effects were likely to be welfare improving.