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The Business of
Health Care Report Because September begins the period when most employees are making benefit choices, our topics for this month focus on managed care. This report covers a general overview of the major managed care players and types of coverages in North Texas. The North Texas marketplace now is dominated by the big four: Aetna, United Healthcare, CIGNA, and Blue Cross and Blue Shield of Texas with almost 2.5 million insured. These well-known companies emerged as market leaders after a series of consolidations: Aetna with US Healthcare and later Prudential, United with several independent HMO organizations plus Metropolitan Life and Travelers, and Blue Cross and Blue Shield with NYLCare. In the second tier are PacifiCare (including the former Harris Methodist Health Plan), Private Healthcare Systems, North Texas Healthcare Network, and UniCare Life & Health totaling about 750,000 insured. Seventy-nine percent of consumers are enrolled in some type of insurance program, and this is projected to rise to 83 percent by 2005 depending on the economy. About 7 percent of the population in North Texas are covered by Medicare, 3 percent by Medicaid, 31 percent by HMOs and 49 percent by PPO types of contracts. HMOs became more popular in the mid-1990s as insurers and employers provided incentives for employees to opt into lower cost plans. For awhile, this shift in coverage stabilized rates. But HMO profitability plummeted, drug prices rose, utilization remained high and technology prices increased-all boosting HMO rates higher during the past two years. The type of health coverage projected to grow least between 2000 and 2005 is HMOs, with only a .4 percent increase. If you have comments on health care or suggestions for topics to be addressed on this program, e-mail me at DougHawthorne@TexasHealth.org. Sources: THR Managed Care Department, Medical Data International, Arthur Andersen, Interstudy Competitive Edge ©
2001 Texas Health Resources |
