As the article states, we have a "mature" market here...in other words, it has been around California a lot longer than most places...BD

Health maintenance organizations in Orange County posted steady growth during the past year, though a pair of plans saw their enrollments surge.
The county’s managed care sector was relatively quiet last year, compared to 2005, when UnitedHealth Group Inc. bought out Cypress-based PacifiCare Health Systems Inc. for $9.2 billion.
The nine HMOs on this week’s Business Journal list reported a 6% increase in local membership to 1.23 million people, compared to 1.16 million the previous year.
The list is ranked by enrollment, with figures compiled from the California Department of Managed Care and the companies themselves.
OC and California are considered mature HMO markets—the state is an influential region in the growth and development of managed care.
HMOs work to control healthcare costs through a combination of preventive care, emphasis on steering patients to primary care doctors and carefully watching the use of more expensive specialty doctors.
Huge membership gains for HMOs were common back in the 1980s and 1990s, as businesses sought ways to control rising healthcare costs. The pace of enrollment has slowed considerably after different forms of health plans emerged.
Meanwhile, a backlash against HMOs from consumers, doctors and politicians also took a bite out of enrollment, though sentiments have improved during the past decade.

Orange County Business Journal Online

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