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The Diabetes Educator

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Medical Care Research and Review
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Wrestling with Typology: Penetrating the "Black Box" of Managed Care by Focusing on Health Care System Characteristics

Cindy Brach

Agency for Healthcare Research and Quality, Center for Organization and Delivery Studies

Linda Sanches

Department of Health and Human Services, Office of Assistant Secretary for Planning and Evaluation

Donald Young

Health Insurance Association of America

James Rodgers

American Medical Association

Holly Harvey

Department of Health and Human Services, Office of Assistant Secretary for Planning and Evaluation

Thomas McLemore

National Center for Health Statistics, Division of Health Care Statistics

Irene Fraser

Agency for Healthcare Research and Quality, Center for Organization and Delivery Studies

The health care system has undergone a fundamental transformation undermining the usefulness of the typology of the health maintenance organization, the independent practice association, the preferred provider organization, and so forth. The authors present a new approach to studying the health care system. In matrix form, they have identified a set of organizational and delivery characteristics with the potential to influence outcomes of interest, such as access to services, quality, health status and functioning, and cost. The matrix groups the characteristics by domain—financial features, structure, care delivery and management policies, and products—and by key roles in the health care system—sponsor, plan, provider intermediary organization, and direct services provider. The matrix is a tool for researchers, administrators, clinicians, data collectors, regulators, and other policy makers. It suggests a new set of players to be studied, emphasizes the relationships among the players, and provides a checklist of independent, control, and interactive variables to be included in analyses.

Medical Care Research and Review, Vol. 57, No. 3 suppl, 93-115 (2000)
DOI: 10.1177/1077558700573006
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