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Sep
11

HMOs cost less because they pay less

HMOs are cheaper than other forms of health insurance due to lower provider costs. At least that’s what an analysis of a 2004 study comparing HMOs to other forms of insurance discussed by Jason Shafrin in a post on Healthcare Economist says.
The difference amounted to 9.3%, with no measurable difference in utilization rates or risk selection between HMOs and other plans.
So, as an industry, HMOs are not more efficient because they are better at managing care or selecting risk, they are cheaper because they pay providers less. I would note that the analysis is based on data from the nineties, so perhaps a more accurate statement is that in the past HMOs were more efficient.
I don’t know if that’s the case today.


One thought on “HMOs cost less because they pay less”

  1. I was REALLY disappointed that they used such an old data set for their study. I have to assume it was all they could get. For such an important finding, I would hope someone could reproduce it with some more recent and useful data.

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Joe Paduda is the principal of Health Strategy Associates

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