Buying a Health Plan - Introduction

The Pennsylvania Health Care Cost Containment Council

The Pennsylvania Health Care Cost Containment Council was created by the Pennsylvania legislature in 1986 to stimulate competition in the health care marketplace by providing useful information about the cost and quality of health care. Previous Council reports have focused on hospital-specific data and, to a limited degree, physician-specific data. The health care industry, however, is experiencing enormous change involving a shift in traditional roles, especially as it relates to the management of health care.

As payors exert more influence over providers, and purchasers seek to choose from multiple "managed care options," it is fair to recognize that providers are no longer solely responsible for the delivery of quality care. Payors are evolving from the traditional approach of financing the delivery of health care to one of influencing the organization of the delivery system. While it is important to remember that patients are not treated by payors, it is increasingly the case that in today's market, payors directly or indirectly influence the delivery of care.

As these newly emerging and evolving health systems work to achieve positive outcomes for their health plan members in the most cost-efficient manner, it is important to monitor and report on these results. In late 1995, the Pennsylvania Health Care Cost Containment Council, through a series of strategic planning sessions, identified as its primary future role to develop information about the impact and influence of managed care on health care cost and quality issues.

What Is the Purpose of This Booklet?

Those who make decisions about purchasing health care benefits for their employees or members are confronted with a new array of choices calling themselves managed care. This booklet addresses the most common concerns of purchasers about cost, service, access, and quality. It provides small- and medium-size employers, health benefits plan administrators, and union officials a framework to begin a constructive dialogue with those plan representatives. This booklet is intended to be a starting point of questions to ask and issues to raise before making any choices.