Does Israel not have competition between HMOs?  Israelis are insured nationally and are then free to go to whichever HMO they wish. They can switch every two months.

The largest, Clalit, has 15 hospitals, 1,500 outpatient clinics and 4.5m patients. It has just claimed that chronic disease management programmes have enabled it to cut the cost of diabetic patients from 3.5 times the average to just under 2 times - a 40% cut (that would save the UK £4bn).

On 22 May 2012 23:23, Joseph White <[log in to unmask]> wrote:
Simon appears to have ignored the phrase "heavily regulated".

The degree of integration could also be questioned.  UCLA is heavily integrated with what, by whom?


On Tue, May 22, 2012 at 5:44 PM, Fred Hyde <[log in to unmask]> wrote:
Re: "managed competition"
 
Another unicorn, Michael, spotted only in the minds of those surveying the Jackson Hole scenery, long ago, and not since.  Like more recent "unicorn" phenoms, the fact that we can name it does not mean that it exists.

Fred Hyde, MD
Fred Hyde & Associates, Inc.
57 Main Street
Ridgefield, CT 06877
 
[Clinical Professor, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY]


-----Original Message-----
From: Michael Gusmano <[log in to unmask]>
To: AAHPN <[log in to unmask]>
Sent: Tue, May 22, 2012 5:33 pm
Subject: Re: 'integrated care'

It is not clear to me that something that looks like managed competiton exists in southern California...but even if it does, we have not been able to replicate this anywhere else in the country.

Sent from my Verizon Wireless Phone


-----Original message-----
From: "Stevens, Simon L" <[log in to unmask]>
To: Michael Gusmano <[log in to unmask]>, "[log in to unmask]" <[log in to unmask]>
Sent: Tue, May 22, 2012 21:29:21 GMT+00:00
Subject: RE: 'integrated care'

....southern California perhaps?

-----Original Message-----
From: Anglo-American Health Policy Network [mailto:[log in to unmask]]
On Behalf Of Michael Gusmano
Sent: Tuesday, May 22, 2012 3:48 PM
To: [log in to unmask]
Subject: Re: 'integrated care'

Following on that, has anything that looks like heavily regulated market
competition among integrated care organizations ever been established
anywhere?

Cheerfully,
Michael

Sent from my iPad

On May 22, 2012, at 12:38 PM, "Calum Paton" <[log in to unmask]>
wrote:

> Chris,
>
> No offence - was having fun being Mr. Grumpy.
>
> Re the serious debate: I do feel strongly that the health reform
> industry in England has (what's the quote from Harold Wilson) taken
> minutes* and wasted years.
>
> (*in this case, produced myriads of policy changes in cyclical and
> indeed circular direction of travel)
>
> I know you can have 'integrated care' in a market context, or shall we

> say in a 'post-purchaser/provider split' politics. Competing
> HMOs/Enthoven's original model of managed competition (for Bismarck
> rather than Beveridge
> contexts): in England, citizens could choose among 'HMOs' ie
> commissioner/provider organisations with no geographical catchment
> basis as PCTs/CCGs had/have.....OR.....HAs/ PCTs/CCGs could be the
> purchaser/commissioner choosing among 'integrated care organizations'
> ie the citizen is still with the geographical purchaser, which chooses

> among different 'integrated' providers.
>
> But to me these are Heath Robinson-esque, tortuous means of ticking
> the 'market' box. This is done either on the grounds of ideology or
> out of pragmatism (ie Old Tory/ New Labour/Coalition neo-liberalism is

> the only show in town) ....OR on the grounds that integrated care
> without competition is bound to lead to what Simon Stevens calls
> doctors colluding behind the bike-sheds.
>
> But the 'empirical' question then becomes: is 21 years of market
> economics moderated by 'garbage-can' (Cohen, March and Olsen) politics

> more efficient/effective than a planned, integrated health service
> with appropriate targets and outcome criteria?  Put it another way: if

> all the investment' in commissioning/the market/whatever had been
> applied instead to improving and integrating a non-market NHS, would
> we have got just as much benefit or more?
>
> Best, Calum

This e-mail, including attachments, may include confidential and/or
proprietary information, and may be used only by the person or entity
to which it is addressed. If the reader of this e-mail is not the intended
recipient or his or her authorized agent, the reader is hereby notified
that any dissemination, distribution or copying of this e-mail is
prohibited. If you have received this e-mail in error, please notify the
sender by replying to this message and delete this e-mail immediately.