Health Plan Task Force -- Forum Objectives

Health Plan Task Force

AAUP
American Association of University Professors

About the Report on Physician Reimbursement

Go to:    Each year during open enrollment, you receive a packet from the Employee Benefits Department explaining the different plan options and their costs and a comparison of plan designs, including information about coverage, deductibles, copayments, etc. Also available to you (usually through your department) are lists of physicians available to subscribers of the different plans. What has always been missing is information about the business side, i.e., the "management" of managed care.

The task force commissioned Matt Maciejewski, a research assistant in the School of Public Health, to investigate how reimbursements to physicians are handled by the health plans available to University employees. His report is available on this Web site.

The factual information in this report is accurate to the best of our knowledge. Matt contacted each of the health plans, and received the information about their reimbursement strategies directly from them. All of the health plan companies had a chance to read a preliminary version of the report and to respond. In particular, the information in the section titled Payment Methods Used by Your Health Plan is a summary of information supplied by the companies.

The controversial part of the report concerns the implications found in the section titled How Do Health Plans Pay Physicians? The basic question is this: do the business arrangements between health plan companies and clinics have any effect on the medical care provided to the patient? The opponents of managed care contend that these business arrangements have a serious negative impact on patient treatment, including denial of neccessary treatment. The supporters of managed care contend that the arrangements have a positive impact on patient treatment, especially in the area of preventive medicine.

The opinions expressed or implied in the report are those of Matt Maciejewski and do not necessarily represent the opinions of members of the task force. In particular, there is no consensus on the task force about the implications of reimbursement policies. However, the task force feels that members of the University community should have this information available to them as they make their open enrollment choices.

   Report

Back to:

   Open Enrollment Resources

Task Force Home Page



The report: How are University Employees Affected by Health Plan Payments to Physicians?

Back to: Open Enrollment Resources

Task Force Home Page

Last update: October 12, 1998

Health Plan Task Force
		AAUP American Association of University Professors

		About the Report on Physician Reimbursement
Go to:		Each year during open enrollment, you receive a packet from the Employee Benefits Department explaining the different plan options and their costs and a comparison of plan designs, including information about coverage, deductibles, copayments, etc. Also available to you (usually through your department) are lists of physicians available to subscribers of the different plans. What has always been missing is information about the business side, i.e., the "management" of managed care. The task force commissioned Matt Maciejewski, a research assistant in the School of Public Health, to investigate how reimbursements to physicians are handled by the health plans available to University employees. His report is available on this Web site. The factual information in this report is accurate to the best of our knowledge. Matt contacted each of the health plans, and received the information about their reimbursement strategies directly from them. All of the health plan companies had a chance to read a preliminary version of the report and to respond. In particular, the information in the section titled Payment Methods Used by Your Health Plan is a summary of information supplied by the companies. The controversial part of the report concerns the implications found in the section titled How Do Health Plans Pay Physicians? The basic question is this: do the business arrangements between health plan companies and clinics have any effect on the medical care provided to the patient? The opponents of managed care contend that these business arrangements have a serious negative impact on patient treatment, including denial of neccessary treatment. The supporters of managed care contend that the arrangements have a positive impact on patient treatment, especially in the area of preventive medicine. The opinions expressed or implied in the report are those of Matt Maciejewski and do not necessarily represent the opinions of members of the task force. In particular, there is no consensus on the task force about the implications of reimbursement policies. However, the task force feels that members of the University community should have this information available to them as they make their open enrollment choices.
	Report
Back to:
	Open Enrollment Resources Task Force Home Page


The report:	How are University Employees Affected by Health Plan Payments to Physicians?

Back to:	Open Enrollment Resources
		Task Force Home Page