Studies suggest that intensity of health maintenance organization competition may have some effect on HMO coverage prices and provider reimbursement rates, according to officials at the U.S. Government Accountability Office.
GAO researchers come to that conclusion in a review of 41 peer-reviewed scholarly articles concerning the effects of the level of HMO competition. The researchers prepared the review for Sen. Herbert Kohl, D-Wis., chairman of the Senate Judiciary Committee’s antitrust subcommittee.
The researchers wanted to include data on preferred provider organization plans and other types of plans, but “reliable, longitudinal data to measure concentration, that is, the number of competitors and their relative market share,” are available mainly for HMOs, and not for other types of plans, John Dicken, a GAO director, writes in a summary of the GAO researchers’ findings.
Only 6 of the 41 articles reviewed provided data on non-HMO health coverage products, Dicken writes.
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In the studies that cover the effects of HMO market concentration on pricing, the authors “generally found that more competitive markets were associated with lower premium rates, but that mergers have not led to sustained premium increases,” Dicken writes.