Although Medicare has been studying post-retirement alternatives for nearly a decade, many issues remain to be addressed. In this section (1), we highlight HCFA`s demonstration programs for the extension and refinement of risk contracts, (2) describe ongoing research and will provide answers to many of these questions; and (3) discuss the direction of future policy in the middle of the Medicare program, while highlighting several issues related to these new trends. Unlike hospital care, where HOV has a strong incentive to reduce utilization rates, incentives for outpatient care are mixed. On the one hand, MMOs are encouraged to encourage the use of outpatient care when outpatient care can replace more expensive hospital care. On the other hand, the per capita payment of the package strongly encourages the reduction of the use of all services, including outpatient services. In its in-depth review, Luft found that the differences between HMO`s services and services sectors were mixed in terms of the use of outpatient services. While a majority of the studies studied showed that HMO participants had a slightly higher number of outpatient visits, a significant minority of studies found the opposite result. However, an important pattern of these studies has been that outpatient attendance rates among PPI participants tend to be higher than among other IMO participants. The guarantee is a fixed amount per patient per unit of time paid in advance to the physician for the provision of health care. The actual amount of money paid is determined by the offers, the number of patients involved and the period during which the services are provided. Head administration rates are developed using local costs and average service usage and can therefore vary from region to region of the country. Many plans define a pool of risks as a percentage of the premium payment.

Money from this pool of risks is denied to the doctor until the end of the exercise. If the health plan works well financially, the money goes to the doctor; If the health plan is bad, the money is maintained to pay the cost of the deficit. The Office of Research and Demonstrations supports several studies of AAPCC`s methodology, including the feasibility of integrating health adjustments and the study of the five-year deferred method for the moving average for calculating adjustment factors in counties. Most of these research activities will be completed in 1986 and 1987 and will provide the HCFA with comprehensive information to refine the current Medicare HMO program and to develop new directions for head policy.