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Types of US Health Care Systems

Managed Care has been increasing in the US since the 90's

Table from Wikipedia Jan 2012

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In the PPO the customer has the most to gain from being healthy, since there is an annual deductible

From Wikipedia Jan 2012

In terms of using such a plan, unlike an HMO plan, which has a copayment cost share feature (a nominal payment generally paid at the time of service), a PPO generally does not have a copay and instead offers a deductible and a coinsurance feature. The deductible must be paid in full before any benefits are provided.
If the PPO plan is an 80% coinsurance plan with a $1,000 deductible, then the patient will pay 100% of the allowed provider fee up to $1,000. After this amount has been paid by the patient, the insurer will pay 80% of subsequent fees and the patient will pay the remaining 20%.
Charges above the allowed amount are not payable by the patient or insurer but instead are written off as a discount by the physician.

The last sentence shows another good reason to use vitamin D - to minimize cost of complications.

NPR Health Insurers - 2009 - has an interactive map



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Blue Cross Blue Shield

  • 99 million members
  • 39 companies

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United HealthCare

  • 70 million Americans
  • 668,230 physicians and health care professionals
  • 5,174 hospitals.

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National Committee for Quality Assurance Health Insurance Plan Rankings 2011-12

(not largest market share, but highest rated)

Top 10 Medicare Health Insurance Plans

1. Kaiser Foundation Health Plan of Northern California (HMO)
2. Kaiser Foundation Health Plan of Southern California (HMO)
3. Kaiser Foundation Health Plan of Colorado (HMO)
4. Kaiser Foundation Health Plan of the Northwest (HMO)
5. Gundersen Lutheran Health Plan (HMO)
6. Capital Health Plan (HMO)
7. Kaiser Foundation Health Plan of Hawaii (HMO)
8. Tufts Associated Health Maintenance Organization (HMO)
9. Geisinger Gold Classic (HMO)
10. Kaiser Foundation Health Plan of the Northwest (Demonstration Project) (HMO)

entire list is attached at the bottom of this page

Also attached: AMA HMO market share by state: 2007
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How much are you worth to HMOs?

By their calculations, Medicare Advantage (HMO or similar managed-care plan) enrollees have a “value per member" of $6,000 in a merger or acquisition.
That compares with $1,500 for commercial plans – the ones that employers offer but in which the insurer takes the financial risks – and $1,200 per member for Medicaid plans.
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See also Vitamin D Life

Attached files

ID Name Comment Uploaded Size Downloads
991 Rise of managed care in US.jpg Managed Care admin 01 Jan, 2012 14:05 21.33 Kb 1032
990 Market share Wash 2009.jpg Washington admin 01 Jan, 2012 04:02 5.82 Kb 648
989 Martket Share Calif 2009.jpg Calif admin 01 Jan, 2012 04:02 4.82 Kb 711
988 Health Insurers 2009.jpg Map admin 01 Jan, 2012 04:01 38.12 Kb 1046
987 AMA HMO market share 2007.pdf AMA 2007 admin 01 Jan, 2012 03:43 263.60 Kb 2138
986 Managed Care Higher price targets copy.jpg how much worth admin 01 Jan, 2012 03:39 94.75 Kb 912
985 HPR2011_Summary_Report_Medicare_10.13.pdf NCQA Dec 2011 details admin 01 Jan, 2012 03:36 1.64 Mb 519
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