Insurance-Based Managed Care Organisations and Products

  • Volker Eric Amelung
Part of the Springer Texts in Business and Economics book series (STBE)


The Blue Cross and the Blue Shield health plans were the first health insurance plans in the United States. Together with these insurances, the first health maintenance organisations (HMOs) were also formed in the midst of the Great Depression. Some of the pioneering HMOs include the Kaiser Foundation Health Plans (1937), the Group Health Association (organised by the Home Owner’s Loan Corporation in 1937), the Health Insurance Plan (1944) and the Groups Health Cooperative of Puget Sound (1947). The basic structure of independent practice association (IPA) model HMOs was developed as competition for the group-practice-based HMOs in 1954.


  1. AHIP (America’s Health Insurance Plans). (2017). 2016 Survey of health savings account – High deductible health plans. Washington, DC. Last accessed March 13, 2018, from http://www.
  2. Amelung, V. E., Binder, S., Bertram, N., Chase, D. P., & Urbanski, D. (2017). Die elektronische Patientenakte – Fundament einer effektiven und effizienten Gesundheitsversorgung. Heidelberg: Stiftung Muench.Google Scholar
  3. Atchinson, B. K., & Fox, D. M. (1997). The politics of the health insurance portability and accountability act. Health Affairs, 16(3), 146–150.CrossRefGoogle Scholar
  4. Barrett, D. (1997). Health maintenance organizations. In K. Miller & E. Miller (Eds.), Making sense of managed care (Vol. 1, pp. 47–62). San Francisco: American College of Physician Executives.Google Scholar
  5. Basler Group. (2016). Mandated benefits: 2016 compliance guide. New York: Wolters Kluver.Google Scholar
  6. Blakeney, B., Carleton, P. F., Mc Carthy, C., et al. (2009). Unlocking the power of innovation. The Online Journal of Issues in Nursing, 14(2), 1.Google Scholar
  7. Brown, L. D. (1998). The evolution of managed care in the US. PharmacoEconomics, 14(Suppl 1), 37–43.CrossRefGoogle Scholar
  8. Buntin, M. B., Haviland, A. M., McDevitt, R., & Sood, N. (2011). Healthcare spending and preventive care in high-deductible and consumer-directed health plans. The American Journal of Managed Care, 17(3), 222–230.Google Scholar
  9. Bureau of Labor Statistics. (2011). Last accessed March 13, 2018, from
  10. Cacace, M. (2011). Das Gesundheitssystem der USA: Governance-Strukturen staatlicher und privater Akteure. Frankfurt am Main: Campus.Google Scholar
  11. Chen, C., Garrido, T., Chock, D., et al. (2009). The Kaiser Permanente electronic health record: Transforming and streamlining modalities of care. Health Affairs, 28(2), 323–333.CrossRefGoogle Scholar
  12. Christensen, K., & Silvestre, A. (2010). Harvesting value – Making health personal. In L. Liang (Ed.), Health – Using electronic health records to transform care delivery (pp. 139–156). San Francisco: Pfeiffer.Google Scholar
  13. Cooper, P., Simon, K., & Vistnes, J. (2006). A closer look at the managed care backlash. Medical Care, 44(5), 4–11.Google Scholar
  14. Crossen, F. J., & Tollen, L. A. (2010). Partners in health, how physician and hospitals can be accountable together. San Francisco: Jossey-Bass.Google Scholar
  15. DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. (2010). Income, poverty, and health insurance coverage in the United States: 2009. U.S. Census Bureau, current population reports (pp. 60–238). Washington, DC: U.S. Government Printing Office.Google Scholar
  16. Department of the Treasury. (2017). 2016 health savings accounts and other tax-favored health plans. Publication 969. Accessed April 16, 2017, from
  17. Detmer, D., Bloomrosen, M., Raymond, B., et al. (2008). Integrated personal health records: Transformative tools for consumer-centric care. BMC Medical Informatics and Decision Making, 8(45), 3.Google Scholar
  18. Dixon, A., Greene, J., & Hibbard, J. (2008). Do consumer-directed health plans drive change in enrollees’ health care behavior? Health Affairs, 27(4), 1120–1131.CrossRefGoogle Scholar
  19. Draper, D. A., Hurley, R. E., Lesser, C. S., & Strunk, C. (2002). The changing face of managed care. Health Affairs, 21(1), 11–23.CrossRefGoogle Scholar
  20. Dudl, R. J., Wang, M. C., Wong, M., & Bellows, J. (2009). Preventing myocardial infarction and stroke with a simplified bundle of cardioprotective medications. American Journal of Managed Care, 15(10), e88–e94.Google Scholar
  21. Erdmann, Y. (1995). Managed Care. Veränderungen im Gesundheitswesen der USA in den letzten 30 Jahren. Baden-Baden: Nomos.Google Scholar
  22. Faber, M., Bosch, M., Wollersheim, H., Leatherman, S., & Grol, R. (2009). Public reporting in health care: How do consumers use quality-of-care information? A systematic review. Medical Care, 47(1), 1–8.CrossRefGoogle Scholar
  23. Fasano, P. (2013). Transforming health care – The financial impact of technology, electronic tools and data mining. Hoboken, NJ: Wiley.Google Scholar
  24. Feldman, R., Parente, S. T., & Christianson, J. B. (2007). Consumer-directed health plans: New evidence on spending and utilization. Inquiry, 44(1), 26–40.CrossRefGoogle Scholar
  25. Fox, P. D., & Kongstvedt, P. R. (2013). A history of managed care and health insurance in the United States. In P. R. Kongstvedt (Ed.), Essentials of managed health care. Burlington: Jones & Bartlett Learning.Google Scholar
  26. Fuchs, B., & James, J. A. (2005). Health savings accounts: The fundamentals. Washington, DC: National Health Policy Forum (NHPF). Last accessed March 13, 2018, from HSAs_04-11-05.pdf
  27. Fuchs, B., & Potetz, L. (2007). The fundamentals of health savings accounts and high-deductible health plans. Washington, DC: National Health Policy Forum (NHPF). Last accessed March 13, 2018, from library/background-papers/BP_HSAs&HDHPs_Fundamentals_04-23-2007.pdf
  28. Garrido, T., & Chase, A. (2010). Making it matter: Value and quality. In L. Liang (Ed.), Health – Using electronic health records to transform healthcare delivery (pp. 89–107). San Francisco: Jossey-Bass.Google Scholar
  29. Garrido, T., Raymons, B., Jamieson, L., et al. (2004). Making the business case for hospital information systems – A Kaiser Permanente investment decision. Journal of Health Care Finance, 31(2), 16–25.Google Scholar
  30. Haeckl, D. (2010). Neue Technologien im Gesundheitswesen: Rahmenbedingungen und Akteure. Wiesbaden: Gabler Verlag.Google Scholar
  31. Harris, J. S., & Jaffe, M. (2013). Reducing cardiovascular morbidity and mortality among Kaiser Permanente Northern California members. Last accessed March 13, 2018, from
  32. Hibbard, J. H., Greene, J., & Tusler, M. (2008). Does enrollment in a CDHP stimulate cost-effective utilization? Medical Care Research and Review, 65(4), 437–449.CrossRefGoogle Scholar
  33. Janus, K. (2003). Managing health care in private organizations. Transaction costs, cooperation and modes of organization in the value chain. Frankfurt am Main: Peter Lang.Google Scholar
  34. Jost, T. S., & Hall, M. A. (2005). The role of state regulation in consumer-driven health care. American Journal of Law & Medicine, 31, 395–418.CrossRefGoogle Scholar
  35. Kaiser Permanente. (2015). Annual report 2015.Google Scholar
  36. Kaiser Permanente News Center. (2013). Last accessed March 13, 2018, from
  37. KFF [Kaiser Family Foundation], & HRET [The Henry J. Kaiser Family Foundation & Health Research and Education Trust]. (2010). Employer health benefits 2010, annual survey. Menlo Park/Chicago: Kaiser Foundation & HRET. Last accessed March 13, 2018, from
  38. KFF [Kaiser Family Foundation], & HRET [The Henry J. Kaiser Family Foundation & Health Research and Education Trust]. (2017). Employer health benefits 2016, annual survey. Menlo Park/Chicago: Kaiser Foundation & HRET. Last accessed March 13, 2018, from
  39. Knight, W. (1998). Managed care. What it is and how it works. Gaithersburg: Aspen.Google Scholar
  40. Kongstvedt, P. R. (2009). Managed care: What it is and how it works (3rd ed.). Sudbury: Jones & Bartlett.Google Scholar
  41. Liang, L. (2010). Setting the course. In L. Liang (Ed.), Health – Using electronic health records to transform healthcare delivery (pp. 1–30). San Francisco: Jossey-Bass.Google Scholar
  42. Liang, L., & Berwick, D. (2010). Connected for health: Transforming care delivery at Kaiser Permanente. San Francisco: Jossey-Bass.Google Scholar
  43. McCarthy, D., Mueller, K., & Wrenn, J. (2009). Kaiser Permanente: Bridging the quality divide with integrated practice, group accountability, and health information technology (Case study organized health care delivery system). New York: Commonwealth Fund.Google Scholar
  44. McCreary, L. (2010). Kaiser Permanente’s innovation on the front lines. Harvard Business Review. Last accessed March 13, 2018, from
  45. OECD [Organisation for Economic Co-operation and Development]. (2016). Better ways to pay for health care. OECD health policy studies. Paris: OECD. Last accessed March 13, 2018, from
  46. Physicians Foundation. (2014). 2014 Survey of America’s physicians. Last accessed July 18, 2016, from
  47. Reinhardt, U. E. (2009). The trouble with (in)flexible spending accounts. Economics Blog of the New York Times. Last accessed March 13, 2018, from
  48. Robinson, J. C. (2005). Managed consumerism in health care. Health Affairs, 24(6), 1478–1489.CrossRefGoogle Scholar
  49. Rosenthal, M., Hsuan, C., & Milstein, A. (2005). A report card on the freshman class of consumer-directed health plans. Health Affairs, 24(6), 1592–1600.CrossRefGoogle Scholar
  50. RWJF/HCFO (The Robert Wood Johnson Foundation/Changes in Health Care Financing & Organisation). (2011). High deductible health care coverage: Snapshot of some mixed evidence. Accessed November 10, 2012, from some-mixed-evidence
  51. Sacramento Business Journal. (2011). HMO report card rates Kaiser “excellent”, 11.03.2011.Google Scholar
  52. Sanofi. (2002). HMO-PPO/Medicare-Medicaid managed care digest series (Vol. 5). Bridgewater.Google Scholar
  53. Sanofi. (2006). Managed care digest series, 2006. Bridgewater: HMO-PPO Digest.Google Scholar
  54. Sanofi. (2015). Managed care digest series, 2016. Bridgewater: HMO-PPO Digest.Google Scholar
  55. Schreyögg, J. (2003). Demographic development and moral hazard: Health insurance with medical savings accounts. The Geneva Papers on Risk and Insurance, 29(4), 689–704.CrossRefGoogle Scholar
  56. Shi, L., & Singh, D. A. (2012). Delivering health care in America: A systems approach, Jones & Bartlett Learning (5th ed.). Sudbury.Google Scholar
  57. Shore, D. A. (2005). The trust prescription for healthcare: Building your reputation with consumers. Chicago: Health Administration Press.Google Scholar
  58. Silvestre, A. L., Sue, V. M., & Allen, J. Y. (2009). If you build it, will they come? The Kaiser Permanente model of online health care. Health Affairs, 28(2), 334–344.CrossRefGoogle Scholar
  59. Volk, J., & Giovannelli, J. (2017, April). Who would gain under the proposal to expand health savings accounts? To the Point, The Commonwealth Fund. Last accessed March 13, 2018, from
  60. Wagner, E. R., & Kongstvedt, P. R. (2013). Types of health insurers, managed health care organizations, and integrated health care delivery systems. In P. R. Kongstvedt (Ed.), Essentials of managed health care. Burlington: Jones & Bartlett Learning.Google Scholar
  61. Weiner, J., & De Lissovey, G. (1993). Razing a tower of Babel: A taxonomy for managed care and health insurance plans. Journal of Health Politics, Policy and Law, 18, 75–103.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Volker Eric Amelung
    • 1
    • 2
  1. 1.Institute for Epidemiology, Social Medicine and Health Systems ResearchHannover Medical SchoolHannoverGermany
  2. 2.Institute of Health Sciences Research INAV GmbHBerlinGermany

Personalised recommendations