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Show Any Willing Provider: An Unacceptable Risk for a Marginal Gain Samuel Sutton sirable and AWP critics cite both as reasons to oppose the idea. However, it is important to remember that the Jensen study did not focus specifically on AWP legislation or even exclusively on only state-level mandates. Since AWP was a relatively small of the study, one cannot conclude that AWP legislation by itself will cause the consequences cited in their conclusion. In addition, the authors find federal mandates have the greatest impact on the healthcare market, while AWP has only been enacted at the state level thus far (Jensen and Morrisey, 1999, p. 454). While the Jensen study does provide some ammunition for AWP opponents, it turns out to be rather inconclusive and far from irrefutable. The Lewin-VHI study. The "Lewin-VHI Study" was completed and published in 1995, and despite its age, its findings are still important and are widely cited by AWP opponents. It was prepared for the Healthcare Leadership Council, the Alliance for Managed Care and the Health Insurance Association of America by the Virginia-based health firm Lewin-VHI, Inc. John F. Sheils, David C. Stapleton, and Randall A Haught conducted the study, entitled "The Cost of Legislative Restrictions on Contracting Practices: The Cost to Governments, Employers, and Families". The study focused solely on the costs associated with restricting the contracting practices of MCOs, thus making it one of the most relevant studies to date in the AWP debate. The study begins by citing several other studies, most of them also from Lewin-VHI, indicating that MCOs have been able to secure healthcare savings of up to 23% (Sheils et al., 1995, pp. ii-iii). That same data also indicates that the more restrictive a MCO plan becomes, the more savings it is able to secure. The study goes on to say that "based upon an analysis of states that already have selective contracting restrictions, we estimate that this type of legislation has been associated with a substantial reduction in the growth of HMO enrollment in states with these laws" (Sheils et al., 1995, p. vi). One might assume that once an MCO is no longer able to restrict patient choice it would become more appealing to consumers - especially if it generally offered lower insurance premiums than other plans. Their analysis also indicates "that the rate of growth in health spending generally declines as the percentage of the population enrolled in HMOs increases." (Sheils et al., p. vi). Based on these findings, the authors projected that if AWP legislation were adopted across America in 1995, healthcare costs would have risen by $74.7 billion between 1996 and 2002. They went on to predict that under a national MPOS mandate (i.e. the type of law proposed in Utah), health costs would have risen by a staggering $92.8 billion in that same period (Sheils et al., p. viii). However, the Lewin study admits that it is not fully conclusive, acknowledging "several important limitations in the data used". "For example, [their] analysis of states with AWP legislation may understate the impact of these laws on HMO formation because many of these states have enacted only rel' atively limited forms of selective contracting restrictions affecting only certain groups of plans and providers." (Sheils et al., 1995, p. xi). In other words, the differences between the various laws make it difficult to assess their impact in a uniform manner. Also, the study's findings assume that this legislation is adopted on a national level, and their conclu' sions - despite being based on previous facts and findings - are purely speculative. In addition, their conclusions do not speak to any increases (or decreases) in HMO expenses or insurance premiums, but rather only speculate that a decrease in HMO enrollment will serve to increase costs. Also, the age of the Lewin study serves to undermine some of its potential importance, as well as the fact that its projections run only through 2002. However, the American healthcare industry has changed little since then, with only minor changes being made in various states and no major national changes to the system as a whole. Therefore, the Lewin study still presents some relevant and potentially poW' erful findings for opponents of AWP legislation. The Wyatt and Atkinson studies. There has been a plethora of other studies conducted by var-ious research and advocacy groups which can help illuminate the debate over AWP. None have been any more solidly con' elusive than the three mentioned above, but most lend some relevant ammunition to the fight. In particular, two studies done by different consulting firms both predict that AWP laws will increase administrative costs and insurance claims for MCOs (Carroll and Ambrose, 2002, p. 932). Although these studies were conducted rather early on in the debate (Wyatt and Company's study was pub' lished in 1991, and Atkinson and Company's in 1994), both still have some relevance to the AWP opposition since, as previously noted, America's healthcare system and the struC' ture and operation of MCOs have both changed little since the studies were published. However, these studies "rely heavily on simulation techniques to estimate the effect of AWP laws, rather than assessing actual outcomes" (Carroll and Ambrose, p. 932), and are admittedly fifteen and twelve years old, respectively. As such, they cannot be relied on to provide any rock-solid conclusions or predictions, only specu-lation. The Federal Trade Commission The Federal Trade Commission (FTC) also continues to oppose AWP laws, citing: empirical evaluations [that] indicate that [AWP] policies result in higher health care expenditures. One study found that states with highly restrictive any willing provider/freedom of choice laws spent approximately two percent more on health care than states without such policies...This interpretation is supported by another study that found that metropolitan areas with a high intensity of any willing 80 |
