The Cost of Acute Outpatient Primary Care in a Preferred Provider Organization

Bibliographic Data

ID9105130
AuthorsAnnemarie V Wouters, ANNEMARIE WOUTERS (Johns Hopkins University, corresponding author)
Year1990
Volume28
Issue7
Pages573-585
Publication date1990-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-199007000-00004
PMID2366599
OpenAlexW2030038432
LanguageEN
Citations received1
References cited5

This report is a case study analysis of the relative costs of preferred provider organization (PPO) and non-PPO managed episodes. Results indicate that the episode costs of PPO providers are not significantly different from the episode costs of non-PPO providers for general acute primary outpatient health care. PPO provider episode costs were 3.12% higher for acute upper respiratory illness. Higher PPO physician charges of 10-16% appear to be the main reason for relatively higher PPO episode costs. For general primary health care, drug charges are 23% higher in PPO episodes than in non-PPO episodes. Higher physician and drug charges are partially compensated for by diagnostic charges, which are 14-18% lower in PPO-managed episodes. In light of these findings and the cost-sharing arrangement with the PPO, it is likely that the employer/insurer plan paid expenditures for outpatient care will increase, contrary to expectations

Ambulatory care · Cost sharing · Family medicine · Health care · Health plan · Managed care · MEDLINE · Preferred provider organization · Primary care · Global Health Care Issues · Healthcare Policy and Management · Medicine · Nursing · Primary Care and Health Outcomes

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