The Handbook of Employee Benefits: Health and Group Benefits 7/E, 7th Edition

CHAPTER 5Health Care Cost Containment: Demand-Side Approaches

David Harvey

Historically, the path to managing health care costs has been paved with various forms of cost shifting. Health maintenance organization (HMO) plans introduced the primary care physician (PCP) or gatekeeper concept as well as referral requirements for treatment by a specialist. In preferred provider organization (PPO) plan designs, the form of cost-shifting initiatives can involve increasing deductibles and copayments for both office visits and prescription drug charges. In general, most plan designs have adopted a variety of provider contracts and fee schedules with hospitals and physicians, moving away from first-dollar coverage. Finally, as employer premiums have ...