

Snapshots of Change in Fifteen Communities:
Competition in the Health System: Good News and Bad News
Summer 1996
Health Affairs, vol.15, no.2 (Summer 1996): 107-120
Robert Miller
ompetition among health plans, hospitals, and physicians has taken
place in 15 health care markets primarily on the basis of price and secondarily on network
breadth and style of care. In most markets, competition resulted in lower (or slowly
growing) premium prices. Within a type of plan product, competition was leading to similar
prices and networks and was reducing product differentiation among health plans.
Competition was not taking place on the basis of measured and reported quality of care,
which limited the capacity of employers and enrollees to make informed health plan
choices. As a result, there was a substantial gap between competition as envisioned by the
architects of the managed competition model and competition as it is evolving today.
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