Health ProfessionsHealth PolicyHealth Services AdministrationHealth InsuranceHealthcare AdministrationHealthcare PolicyMedicare AdvantageRural Health PolicyRural Health WorkforceRural InsuranceRural Service ProvisionMedicare Plan ChoiceMedicare Rural PolicyPaymentProvider Payment MethodologyRural Differences In UtilizationRural Health Insurance CoverageRural Healthcare Access
Only 17 of the 38 health maintenance organizations (HMOs) that have Medicare risk contracts and offer coverage to commercial clients in rural counties include the rural counties in their Medicare plan service areas. Rural counties in which HMOs offer Medicare coverage have higher average adjusted average per capita costs (AAPCCs), larger populations, and more physicians per capita than rural counties excluded by risk plans. Interviewed plans cite low and erratic AAPCCs, scarcity of potential enrollees, lack of negotiating power with physicians, and adverse selection as drawbacks in rural areas. Proposed changes to the payment methodology would probably lead HMOs to increase their Medicare offerings in urban fringe areas, but not in isolated rural areas.
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Do health maintenance organizations work for Medicare?
Randall Brown, Dolores G. Clement, Jerrold Hill et al. · PubMed · 1993 · 134 citations
Public Affairs, Health Administration, Health Services Administration +17
Common beliefs about the rural elderly: what do national data tell us?
Joan F. Van Nostrand · PubMed · 1993 · 41 citations
Sources of Hospital Cost Variation by Urban-Rural Location
Jerry Cromwell, Janet B. Mitchell, Kathleen A. Calore et al. · Medical Care · 1987 · 33 citations
Health Professions, Health Administration, Health Policy +17
Urban-rural differences in Medicare physician expenditures.
Avi Dor, John Holahan · PubMed · 1990 · 33 citations