Hospitals engaged in risk-sharing arrangements with insurers saw a decline in the percentage of insurance premiums they captured last year, according to a survey released last week by the Los Angeles office of Deloitte & Touche.
However, hospitals continued to capture a larger share than other players, the survey found.
The survey was distributed to 2,552 of the largest U.S. hospitals, of which 187 responded.
Risk-sharing hospitals received 38% of premiums in 1997, compared with 42% in 1996. HMOs saw a slight increase in their share: 16% compared with 15% in 1996. Primary-care physicians held steady at 20%, while specialists captured 21%, up from 19% in 1996.
In Medicare risk pools, hospitals received 43%, compared with 19% for primary-care physicians, 17% for HMOs and 17% for specialists.
The firm said hospitals find it increasingly difficult to maintain the upper hand in risk-sharing arrangements. HMO payers represented 29% of responding hospitals' commercial revenues, up from 24% in 1996. Risk-sharing arrangements account for 31% of HMOs' commercial revenues, the firm said.
The survey showed that hospitals are attempting to manage risk by affiliations with other providers. The percentage of risk-sharing hospitals that have affiliations with physician groups increased to 77% in 1997 from 61% in 1996. Affiliations with other hospitals stood firm at 71%.