Relationship between Marketing Strategies and Risk Selection in Medicare at-Risk HMOs

摘要

The study related the experience of health risk selection with the marketing activities of a non-random sample of 22 Health Maintenance Organizations (HMOs) in 12 cities which were soliciting Medicare At-Risk (TEFRA) enrollments during the summer of 1988. In addition to detailed case studies analyzing the specific marketing decisions of each HMO, a mail survey of enrollees and a comparison group of non-enrollees in each market (total N = 10,035) was conducted to assess the functional health status of the respondents and the factors responsible for enrollment decisions. The results indicated that none of the participating HMOs experienced adverse selection during the study period. Additionally, no evidence was found to indicate any of the plans were pursuing a deliberate strategy of skimming for the healthier beneficiaries. From the variation in attitudes toward specific health plan attributes and benefit offerings, the report suggests that patient self-selection may be a stronger predictor of enrollment than are marketing activities.