Index
A
public subsidies to improve, 18-19
risk selection affecting, 182-183
Accountability, 237
Actuarial techniques
early development of, 56
fairness issues in, 179-182
Administration of health benefit plans
administrative services only agreements, 113, 334
in Canadian system, 110
case studies in, 128-145
complexity of, in U.S., 11-12, 149-152, 232, 240-241
cooperatives for, 127
cost of, 108-110, 151-152, 206, 240
early cost containment strategies, 73-77
employer functions in, 5-6, 11, 121-127, 149-152, 232-233
ERISA on, 303-304
legal issues in, 152-153
risk selection through practices in, 174-175
size of employer and, 121-122, 124-126
state regulation of, 296, 298-299
third-parties for, 113, 126, 152-153, 344
Admission review, 334
Adverse selection, 46, 169, 334,
see also Risk selection
Age
discrimination, protection against, 316
of health plan, related to enrollment age, 178
of individual, vs. group, enrollees, 168 n.1
premiums related to, 173
of uninsured workers, 93
Agency for Health Care Policy and Research, 226
Ambulatory care, definition of, 334
American Association for Labor Legislation, 58-59
American College of Surgeons, 63
American Medical Association
opposition to group health plans by, 70
opposition to social insurance proposals by, 59-60, 63, 65
American Risk and Insurance Association, 41 n.6
Americans with Disabilities Act of 1990, 117-118, 148, 316-317
application to risk selection, 185-187
confidentiality provisions of, 246
legal uncertainties in, 186
medical records management in, 17
medical underwriting in, 182
B
Benefit, definition of, 43, 335
Benefit design, 114-115
basic benefits, 19-20, 193, 249, 258
cost management in, 74-75
diversity in, 10, 122-126, 237-238, 242
employee assistance programs in, 118-119
employee concerns about, 136-137, 145-149
evolution of, 101-102
in health maintenance organizations, 102
health promotion programs in, 116-119
influence on risk selection of, 171-172, 173-174
innovation in, 10, 71-72, 238-239, 242
insurable events in, 44-45, 338
Medicare, 78-79
mental health care in, 104-106
planning, in case study, 130-133, 137-139
regulating, 19-20, 193-194, 249, 258
risk selection affecting, 184-185
in sample request for proposal, 156-158, 162-165
in social insurance, 41-42, 56-57
in workers' compensation programs, 115-116
Biased risk selection, see Risk selection
Blue Cross plans
costs of, 219
HMO sponsorship by, 126
Blue Shield plans
HMO sponsorship by, 126
in Medicare program, 78-79
origins of, 54 n.3, 68-69, 295
Bureau of the Census, Current Population Survey, 88, 93, 96
C
Cafeteria plan, 335
Canada, 22, 32, 33, 110, 151, 252
Capital expenditures, regulation of, 208-209
Capitation, 335
Carve-outs, for retirees, 94-95 n.6
Case management, 335
Case study
contrasting cases, 142-145
employee advisory group in, 135-137
evaluating benefit plans in, 131-133
evaluating proposals in, 137-140
financial management in, 133
goal setting in, 130
implementing new benefit plan in, 140-142
legal issues in, 134
request for proposals in, 137, 155-166
small business concerns in, 143
Catastrophic expense protection, 335
Certificates of need, 209
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) , 335
Claims management
definition of ''claim," 335
in ERISA, 83
in sample request for proposal, 160-161
COBRA, see Consolidated Omnibus Budget Reconciliation Act of 1985
Commercial insurance, 55-56, 71-72
Committee on the Costs of Medical Care (1927), 60-64, 66-67
Community rating, 257
definition of, 336
in early insurance plans, 67
experience rating vs., 47
in social insurance, 42
theoretical basis of, 181
Competition
ability of, to regulate health care, 207, 220-223, 240
among purchasing cooperatives, 18
effect of risk selection on, 169
risk selection as basis for, 183
Complexity of U.S. health care system, 11-12, 149-152, 240-241
Compulsory coverage in social insurance, 41-42, 56-57
recommendations, 251-254
Confidentiality in Americans with Disabilities Act, 185-186, 246
recommendations for, 16-17, 246
worker concerns about, 148
Consolidated Omnibus Budget Reconciliation Act of 1985, 85, 313-314
Consultants, in planning health benefits, 124-126
Continuity of care
problems with, 10-11, 146, 239
research on, 259
Continuity of coverage, 10-11, 239, 259
termination benefits, ERISA on, 84
Cooperatives
health-plan purchasing, 18, 127, 214-215, 247-248, 342
regulating competition through, 191-192
Coordination of benefits, 94-95 n.6, 336
Copayment, 336
Cost management
benefit designs for, 74-75
cost sharing strategies in, 217
early efforts in, 73-77
early federal initiatives, 82
flexible benefits and, 218
growth of government role in, 207-211
health planning in, 75-76, 208-209
health promotion programs in, 218
issues in, 202-204
market-based strategies for, 220-223, 240
in Medicare program, 208-209
in network plans, 217-218
private sector strategies for, 212-220
prospective payment system for, 211
rate-setting programs for, 208-210
risk pool management for, 74
role of, in health care reform, 20, 250-251
self-insurance and, 218
see also Costs of health care;
Utilization management
definition of, 336
effect on cost of care, 217
income-adjusted, 181 n.7
Cost shifting
definition of, 336
employer concerns about, 232
government role in. 211-212
recommendations for controlling, 248
Costs of health care
administrative expenses in, 108-110, 151, 206, 240
caps on enrollee spending, 104
concept of value in, 203-204, 223-227
consumer concerns about, 202
distribution of spending on, 3, 4, 5, 27-28, 167
in early insurance plans, 67-68
economic effects of, 202-203
employer spending on, 4, 27-28, 71 n.17, 207
factors in rise of, 4, 7, 202-204, 221
growth of, 4, 28-29, 61, 78, 108, 204-207
individual's health status affecting, 178-179
inflation as factor in, 204
inpatient vs. outpatient services in, 204
international comparisons of, 4-5, 29-30
market forces in, 220-223
medical care component of, 204-205
medical technology in, 203, 204-206, 224
as obstacle to small group benefit plans, 94
population growth as factor in, 204
premium costs in, 106-108
public program spending on, 5, 207, 274
risk selection and, 183-184
size of group and, 183
tax expenditures in, 110
trends in, 204-206
uncompensated care in, 184, 252
in workers' compensation programs, 115
see also Cost management
Council of Smaller Enterprises, 127
Coverage
continuity of, 10-11, 85, 239, 259, 313-314
issues in legislative reform, 256
mandated continuity of, 313-314
state-mandated, 298
state regulation of, 296-297, 298
see also Benefit design
D
Demographic risk adjustment, 196-197
Dental benefits, 102
Department of Health and Human Services, 88, 89
Department of Labor, Bureau of Labor Statistics, 88-89
Diagnosis-related groups, 197, 211, 336
Disability insurance, 43 n.8
in origins of medical insurance, 51-54
Discrimination
age, protection against, 316
health related, 117-118, 148, 185-187, 236-237
in workplace health promotion programs, 118-119
E
Economic Stabilization Program, 208
Elderly
employment-based insurance for, 90
private insurance for, 77
Eligibility
defining family members for, 89-90 n.5
state-mandated, 101
workplace rules, 93-94
Employee advisory groups, in case study, 135-137
Employee assistance programs, 24, 118-119, 258-259, 337
Employee Retirement Income Security Act of 1974 (ERISA), 82-85, 231-232, 293, 300-313
deemer clause of, 310
employer liability for managed care and, 152-153
federal legal supplements to, 315-317
fiduciary standards in, 304-306
government regulation before, 82
multiple employer welfare arrangements and, 315
preemption of state law by, 306-311
recommendations for amending, 16, 19, 249-250
regulation of self-funded plans under, 310-313
reporting requirements of, 303-304
savings clause of, 307-310
underwriting in, 182
vesting in, 302-303
Employment-based health coverage
case study of, 128-145
costs of, 106-111
development of, 3, 27, 49-56, 65-71, 67-71
employee responsibilities in, 145-149
in health care reform, 23-24, 26-27, 36, 207, 230-231, 242-243, 260-261
management activities in, 5-6, 121-127, 149-152, 232
participation in, 5-6, 8-9, 26, 27-28, 89-98, 232-233
private initiatives to control costs in, 212-220
Employment practices
discontinuity in benefit coverage, 10-11, 239
effect of Americans with Disabilities Act on, 185-187
encouraging enrollment in spouse's benefit plan, 92
hiring of smokers, 117-118 n.16, 186
medical screening in hiring, 9, 117-118
ERISA. See Employee Retirement Income Security Act of 1974
European experience, see International comparisons
Experience rating, 47, 112-113, 133, 197, 337
F
Families
deductibles in coverage for, 103
of insured workers, benefits for, 89-92
of uninsured workers, 92-94
Federal Employees Health Benefits Program
origins of, 73
risk selection in, 175-177
Federal regulation
in development of employment-based health plans, 70-71
early social insurance proposals, 60-65
encouraging HMOs, 210
of mental health benefits, 106 n.11
need for, 19, 245-246, 248-250, 251-254
of pre-employment medical screening, 9
see also Employee Retirement Income Security Act of 1974 (ERISA);
State regulation
Fee-for-service plans
definition of, 337
modified, in network plans, 100
Fiduciary
definition of, 337
standards in ERISA, 304-306
Financial Accounting Standards Board, 95
Financial management
ERISA requirements, 84
evaluating benefit options, in case study, 133
retiree benefits as corporate liabilities, 95, 113-114
tax expenditures in health benefits, 110-111
Flexible benefits, 119, 218, 337
Foundations for medical care, 76
France, health care spending in, 30, 32
Fraud, 116
G
Gatekeeper physician, 100, 338
Gender, premiums related to, 173
Geographic variations in coverage, 98, 101
Germany, 36-37 n.3
development of medical insurance in, 53
health care spending in, 30, 32t
premium costs in, 106
risk segmentation in, 46 n.9, 168 n.2
role of employers in, 217 n.5
sickness funds of, 46 n.9, 56, 57
social insurance in, 41 n.6, 42, 57
Group Health Association, 69
Group practice
prepaid, 341
H
Health Care Financing Administration, 88, 89
Health Insurance Association of America, 88, 89, 188 n.13
Health Maintenance Organization Act of 1973, 82
Health maintenance organizations
benefit coverage in, 102
definition of, 338
evaluating, in case study, 130, 132-135
evidence of cost savings in, 218
government encouragement of, 210
group model, 338
growth of, 100
Medicare-contracted, 197
numbers of, 126
open-ended, 340
relative restrictiveness of, 98
risk selection in, 174, 177-178, 179
staff model, 344
state regulation of, 298-299
Health planning, 75-76, 208-209
Health Planning and Resources Development Act of 1974, 209
Healthy People 2000, 116
Heritage Foundation, 37
High-risk individuals, 117-118, 171-172, 199-200
Historical developments, 3, 27
Blue Cross plan, 66-69
in cost management, 73-77
early social insurance proposals, 57-65
government efforts to control health care costs, 207-212
growth of cost of care, 78
key dates of, 52
origins of employment-based health plans, 69, 70-72
origins of medical insurance, 51-56
private insurance initiatives, 65-71
in regulation of insurance, 293-295
in social insurance, 56-57
in utilization review, 76-77
Hospice care, 102
Hospitals
administrative expenses in, 110
cost of uncompensated care in, 184, 252
cost shifting in, 211-212
development of, 53
government cost control programs in, 208-210
prospective payment system in, 211
resource management of, 75-76
I
Indemnity insurance, 98-99, 338
evaluating, in case study, 132-133
Independent practice associations, 126, 338
employee concerns about, in case study, 135-136
evaluating, in case study, 130, 132
evidence of cost savings in, 218
origins of, 75
relative restrictiveness of, 98
risk selection in, 174
Information management under Americans with Disabilities Act, 185-186
analyzing health care data, 88
in establishing health status measures, 198-199, 225
evaluating benefit plans, case study of, 131-133
in risk-adjustment methodologies, 18, 197-198
see also Confidentiality
Innovation
in benefit plan design, 10, 24, 238-239
by commercial insurers, 71-72
in health research, 238
in medical technology, 10, 31, 50
in state regulatory efforts, 249-250
Insurance
actuarial fairness in, 180
administrative costs of, 109-110
administrative practices, regulation of, 296
basis for state regulation of, 293-295
disability, defining, 43 n.8
ERISA preemption and state regulation of, 308-310
growth of, 71-72
indemnity, 98-99
insurable event in, 44-45, 338
language of, 40-47
moral hazard in, 45-47
origins of, 51-56
prepayment, definition of, 44
private, enrollment in, 90
rate regulation of, 296-297
social, 41-42, 56-57, 58-60, 60-65, 181, 344
unfair practices in, 297-298
Insured workers, 89-92
concerns of, in benefit plan, 145-149
employee advisory group, in case study, 135-137
full-year, full-time, 92-93, 337
full-year, part-time, 337-338
health care spending by, 106
International comparisons
defining employment-based systems in, 36
early medical insurance in, 51-56
in health care reform, 36-37
in health care spending, 4-5, 29-34, 239-240
universal coverage, 56-57, 236
see also specific country
J
Japan, health care spending in, 30, 33
K
Kaiser plan
origins of, 69
L
Labor Management Relations Act of 1947, 300
Legal issues
in authority of ERISA, 301
employer liability for managed care, 152-153
federal preemption of state laws by ERISA, 306-311
fiduciary standards in ERISA, 304-306
foundations of state insurance regulation, 294-295
in multiple employer welfare arrangements, 314-315
in review of benefit plan options, in case study, 134
unfair insurance practices, state regulation of, 297-298
Lifestyle factors, 180, 186-187
Loading factor, 339
Louisiana, 108
Low-wage workers
extent of coverage for, 92-93
tax deductions for health care for, 111
M
Managed competition, 190-194
Managed coverage, see Compulsory coverage in social insurance
Marketing practices, risk selection through, 175
Maryland, 209
Massachusetts, 108
McCarran-Ferguson Act, 82, 295, 309
administrative expenses, 108, 110
cost shifting and, 212
Oregon plan for restructuring, 193
Medical organizations
early opposition to health plans by, 69-70
see also American Medical Association
Medical records, see Information management
Medical services
in cost of care, 204-206, 223-226
Medical technology
assessing value of, 225-226
cost of care and, 203, 205-206, 218, 224
development of, 51-53
innovation in benefit design and, 10, 31, 50
Medicare prospective payments and, 211
risk assessment methodologies and, 195-196
role in cost of health care, 205-206
Medicare, 2, 12, 78-79, 208-209, 339
administrative expenses, 108, 110
enrollment history, 79
HMOs in, 20
integrating retiree employment-related coverage with, 94-95 n.6
pharmacy benefits in, 102
prospective payment system in, 211, 212
risk assessment in, 195-196
secondary payers in, 316
use of utilization measures in, 197
Mental health care
cost of, as percentage of health expenditures, 104-106
coverage limits on, 104-106
employee assistance programs for, 118-119
Mississippi, 108
Multiple employer welfare associations, 84, 314-315, 339
N
National Association of Insurance Commissioners, 82, 188 n.13, 295
National Conference on Medical Costs, 212
National Labor Relations Board, 70-71
National Medical (Care) Expenditures Survey, 92
Network health plans
coinsurance in, 103-104
definition of, 340
effect on cost of care by, 217-218
risk selection in, 174
state regulation of, 298-299
types of, 100-101
Norway, health care spending in, 30
O
P
Part-time workers, 90, 337-338
Peer review, 76
Peer review organizations, 210-211
Pepper Commission, 37
Pharmacy benefits, 102, 147 n.4
Physician(s)
early opposition to health insurance, 55
as gatekeepers, 100
impact of employment-based benefits on, 149-152
importance of, in consumer choice, 170
in Medicare program, 78-79
payment, 211
primary care, 341
risk selection in restricted network of, 174
role of, 53
types of, in state-mandated benefits, 101
Point-of-service plans
definition of, 341
features of, 191
growth of, 100
relative restrictiveness of, 98
Preadmission review, 341
Preferred provider organizations, 218, 341
coinsurance in, 104
relative restrictiveness of, 98
risk selection in, 174
state regulation of, 298-299
Premiums
age related to, 173
considerations in regulating, 255
cost of, 106-108
definition of, 341
effect of risk selection on, 175-176
evaluating benefit plan options, in case study, 133
gender related to, 173
risk rating of individuals and cost of, 117
for self-insured groups, 112, 113
workers' compensation, 115
Private insurance, enrollment in, 90
Professional standards review organizations, 210
Prospective Payment Assessment Commission, 212
Prospective payment system
cost shifting and, 211-212
definition of, 342
effect of, 211
origins of, 211
Public opinion
on administration of health care system, 232
compulsory employment-related coverage in, 31
cost concerns in, 202
delivery of health care in, 1-2, 22-23, 31
Employee Benefit Research Institute
of health benefits system, 12-13
Public spending
early social insurance proposals, 57-65, 60-65
financing through reform, 20, 248
international comparisons, 4-5, 32-33, 56-57
for Medicaid, 80
public understanding of, 202
in risk-adjusted payment plans, 17-18
Purchasing cooperatives, see Cooperatives
Q
Quality assurance, 342
Quality of care, 342
definition of, 184
effect of risk selection on, 184-185
health care spending and, 33 n.2
R
Redlining, 97-98
Reform of health care system
administrative issues in, 151-152
alternatives proposed for, 37-38
amending ERISA in, 16, 19, 248-250
American Medical Association stance on, 59 n.8
basic benefit design in, 19-20, 193, 249, 258
confidentiality issues in, 16-17
continuity of care in, 259
cost of, 250-251
employee assistance programs in, 258-259
employer size and, 219-220
high risk individuals in, 199-200
impact of private cost control strategies, 216-220
issues in, 1-3, 35-40, 48, 50, 254-256
managing competition in, 190-194
mandated universal coverage in, 21-23, 251-254
market-oriented approaches to, 7, 22, 207, 220-223, 240
mental health care in, 106 n.11
need for, 1, 14, 17, 47-48, 260
pace of, 227-228
proposals in other countries, 36-37
to reduce risk selection, 14-17, 175-176, 187, 242
research needs for, 256-259
risk-adjusted payments in, 17-18, 194-196, 247, 257
risk sharing and, 261
role of employer in, 14, 22, 23-24, 31, 36, 216-220, 230-231, 242-243, 260-261
role of private sector in, 227-228, 229-230, 260-261
state experimentation in, 249-250
underwriting practices in, 16, 47, 187-190, 245-246, 257
within voluntary system, 243
workers' compensation system in, 115-116
Reimbursement systems
cost shifting and, 211-212
development of, 75
evaluation of, in case study, 133
in Medicare program, 79
in network plans, 100
physician, 211
prospective payment, 211
resource-based relative value scale, 211
Request for proposals, in case study, 137-139, 155-166
Research needs
basic benefit design, 19-20, 258
on continuity of care, 259
employee assistance programs, effects of, 258-259
for health care reform, 23, 256-259
methodologies for risk adjusting, 18, 257
technology assessment, 226-227
underwriting reforms, consequences of, 257
Resource-based relative value scale, 68, 211
Responsible National Health Insurance plan, 37
Retirees, 94-95
benefits for, as corporate liability, 95, 113-114
Retrospective payment, 342
Risk-adjusted payments, 17-18, 194-196, 247, 343
demographic approach to, 196-197
health status measures in, 198-199
methodologies for, 196-199, 257
prior use data for, 197-198
Risk pools, see Risk sharing
Risk segmentation
strategies for reducing, 187, 245-246
Risk selection, 167-169, 200-201
benefit design affecting, 171-174
discrimination and, 9, 236-237
in early insurance plans, 67, 69
effect of Americans with Disabilities Act, 185-187
effect on access, 182-183
effect on costs of care, 183-184
effect on premiums, 175-176
effect on quality of care, 184-185
employer factors contributing to, 170-172
equity issues in, 179-182
evidence of, 177-179
in Federal Employees Health Benefits Program, 175-177
high risk individuals and, 199-200
moral hazard and, 46
in network plans, 174
regulating competition to discourage, 190-194
risk-adjusted payments to reduce, 17-18, 194-196
size of group and, 168
strategies for reducing, 14-16, 187, 245
through administrative practices, 174-175
through individual medical records, 16-17
through marketing practices, 175
underwriting practices and, 173, 187-190, 245-246
universal coverage and, 22, 252
Risk sharing
definition of, 343
importance of, 26
risk pools for, 43, 74-76, 199-200, 343
Rochester, New York, 113, 127, 181 n.8, 218-219
S
Self-insured groups, 343
advantages of, 111-112
in case study, 133
cost savings by, 218
ERISA regulation of, 83-85, 310-313
funding mechanisms for, 111
liability for managed care in, 153
medical underwriting within, 16
related to employer size, 111
risk segmentation and, 47, 168
risk-sharing arrangements for, 112-113
state regulation of, 101, 250, 310-313
stop-loss insurance for, 113
taxing of, 248
trends in, 189
types of, 44
Size of employer
administration of health plan and, 110, 121-122, 124-126
benefit design and, 5-6, 9-10, 99
cost containment strategies related to, 214
costs of health care and, 106, 183, 237
coverage availability related to, 5, 96-97, 232-233
employee assistance programs, 118
employer-financed coverage for retirees and, 95
evaluating benefit plans and, in case studies, 142-145
flexible benefit plans and, 119
health care reform and, 16, 219-220
health promotion programs and, 5-6, 117
self-insurance practices and, 16, 111
Small businesses
cooperative efforts by, 18, 127, 214-215, 247-248
limiting underwriting practices in, 187-190
reasons for not offering health benefits in, 94
see also Size of employer
Smokers, hiring of, 117-118 n.16, 186
Social insurance
development of, 56-57
early proposals for, 58-65
theoretical basis of, 181
Social Security Act, 64, 78, 80
Amendments of 1972, 208-209
Societe Francaise de Bienfaisance Mutuelle, 53
State regulation
benefits mandated by, 19-20, 101, 249, 298
ERISA and, 82-85, 249-250, 306-313
experimentation in, 249-250
extent of, 293
of insurance company management, 296
of insurance rates, 296-297
limiting risk selection through, 181-182
of managed care organizations, 298-299
of Medicare, 79-80
of multiple employer welfare arrangements, 315
origins of, in health care, 293-295
of self-insured groups, 310-313
social insurance initiatives, 58-60
of unfair insurance practices, 297-298
Statistics
administrative expenses, 108-110
benefit design, 102
coinsurance arrangements, 104
in Committee on the Costs of Health Care report (1928-1932), 60-61
consumer concerns about cost of care, 202
cost of mental health care, 104-106
coverage related to size of company, 96, 99
data sources for, 88-89
deductibles, 103
employment-based plans, enrollment in, 1, 27, 71, 236
flexible benefit plans, 119
health care in Rochester, New York, 219
health care spending, 3, 4, 27-28, 78, 204-206, 207
HMO enrollment, 210
industry type as variable in coverage availability, 97
insured populations, 3, 26, 27, 28, 236
insured workers, 89-92
Medicaid, 80
network plan enrollments, 100
premium costs, 106-108
publicly funded health coverage, 4, 27
regional variation in coverage availability, 98, 99
retirees, 94-95
self-insured groups, 111
taxation of health benefit expenditures, 110-111
types of plans offered, 99
uninsured workers, 92-94
worker attitudes toward benefit plans, 148-149, 287-292
workers' compensation benefits, 115
Steelman Commission, 37
Stop-loss coverage
extent of, in self-insured groups, 111
for self-insured groups, 113
types of, 113
Switzerland, 42
T
Taft-Hartley Act of 1947, 70
Tax Equity and Fiscal Responsibility Act of 1982, 85
Taxes, 110-111
deductibility of contributions to health plans, 71, 110-111
flexible benefit packages and, 119
legal supplements to ERISA, 315
in market-based reforms, 222
retiree health benefits as corporate liabilities, 95, 113-114
for self-insured groups, 248
Technology. See Medical technology
Terminating benefits, ERISA provisions on, 84
Third-party administrators, 113, 126, 152-153, 344
Traveler's Insurance Company, 55 n.4
Triple-option plan, 344
Trusts, for self-insurers, 113, 344
U
U.S. Chamber of Commerce, 37
U.S. Public Health Service, origins of, 57
Uncompensated care, 21, 184, 252, 344
Underwriting
in Americans with Disabilities Act, 185, 186
in cooperative plans, 127 n.2
by Council of Smaller Enterprises, 127
definition of, 344
risk selection and, 173, 182, 187-190, 245-246
role of, 47
in small-group market, 16
strategies for limiting, 16, 181-182, 187-190, 245-246, 251-252, 255, 257
Uninsured populations
age of, 93
health of, 183
working, vs. nonworking, in generating uncompensated care, 184 n.9
Unions
in development of employment-based health plans, 70-71
in development of medical insurance, 54, 55, 76
United Kingdom
health care spending in, 30, 33
origins of medical insurance in, 51, 55-56
Universal coverage, 236
employment-based, 21-23, 251-254
Utilization management
definition of, 344
effect of, on cost of care, 217
employer liability for managed care and, 152-153
extent of, in employer benefit plans, 213-214
as measure in risk-adjusting, 197-198
in Medicare, 208
origins of, 76-77
retrospective, 342
V
Voluntary employee beneficiary association, 113
