30 Compensation and Working Conditions Spring 2001

CATHY A. BAKER

IRIS S. DÍAZ

Managed Care Plans and

Managed Care Features:

Data from the EBS to the

NCS

In the 1990s, managed care plans and features had

a prominent role in the discussion of the design and

efficiency of health care plans. In 1997, 95 percent

of all full-time employees in medium and large private

establishments participated in plans with a managed

care emphasis.

Cathy A. Baker and Iris S. Díaz are labor

economists in the Division of Compensation Data Estimation, Bureau of Labor Statistics.

Telephone: (202) 691-6260

E-mail: Baker_C@bls.gov

Díaz_I@bls.gov

The Health Insurance Association of America defines managed care as a collection of interdependent systems that integrate

the financing and delivery of appropriate health care services to covered individuals.1 Since the early 1980s, the

Bureau of Labor Statistics (BLS) has

captured data on managed care

through its compensation surveys—

initially through the Employee Benefits

Survey (EBS)2 and now through the

National Compensation Survey (NCS).

This article presents two distinct perspectives of managed care: Managed

care plans and managed care features.3

Managed care plans serve as an alternative to traditional health care plans

that do not restrict a patient’s choice

of providers. Managed care plans enter into arrangements with selected

health care providers, who agree to furnish a comprehensive set of services

and to implement cost containment and

quality measures. Managed care features are designed to limit costs and

improve the efficiency of service by

setting incentives on specific plan provisions. For example, one managed

care feature could lower costs by reducing nonemergency weekend hospital admissions. (See box for a general list of managed care features and

their definitions.)

Using EBS data for selected years

between 1991 and 1997, this article discusses managed care plans, managed

care features, and changes to be expected in future NCS surveys. The

data come from medium and large private establishments—those with 100

employees or more—that represent, on

average, 33 million full-time employees.

Farms and private households are excluded.

The 1997 EBS concludes the publication of data on medium and large private establishments under the current

survey format. The EBS will publish

two interim products for 1999 and 2000

before becoming fully integrated into

the NCS. After that time, BLS will no

longer conduct independent surveys

of medium and large private establishments, small private establishments,

and State and local governments.
 Compensation and Working Conditions Spring 2001 31

Managed Care Plans and Features

Glossary of Managed Care Terms

Listed below are some of the most common managed care features as defined by the International Foundation of Employee

Benefits in Employee Benefit Plans: A Glossary of Terms, 9th edition, and BLS. Definitions from BLS have the reference “by

BLS” next to the term defined.

Case management. A utilization management technique that focuses on coordinating a number of services needed by clients. It

includes a standardized, objective assessment of client needs and the development of an individualized service or care plan that

is based on the need assessment and is goal oriented.

Claims review. In health care prepayment, the routine examination by a carrier or intermediary of the claim submitted to it for

payment or for predetermination of benefits; may include determination of eligibility, coverage of service, and plan liability. In

quality assurance, examination by an organization of claims as part of a quality review or utilization process.

Concurrent review. The process by which hospital admissions for elective and emergency treatment are certified for appropriateness at the time of service and by which continued stays are verified for medical necessity and level of care. According to the

Handbook of Employee Benefits, 3rd edition, by Jerry S. Rosenbloom (Burr Ridge, IL, Irwin, 1992), concurrent review is an

“onsite” review, and continued stay review is an “offsite” review.

Continued stay review. A review and an initial determination by a utilization review committee during a patient’s hospitalization

of the necessity and appropriateness of continuation of the patient’s stay at a hospital level of care; sometimes called “recertification.”

Discharge planning. A centralized, coordinated program developed by a hospital to ensure that each patient has a planned

program for needed continuing or followup care.

Generic prescription drugs (by BLS). Bioequivalent (same active chemical composition) to brand name drugs, but reimbursed

at a higher payment level.

Hospital bill audit (by BLS). A provision that gives participants an incentive to find overcharges in their hospital bill. Most

plans give the participant a percentage of the money saved by the plan sponsor, up to a specified maximum.

Medical case management (by BLS). An option, often offered by insurance companies, that provides coordinators to handle

high cost claims and recommend specialized care and services targeted to an individual’s treatment goals and needs. Medical case

management is most often used to deal with catastrophic illnesses. The medical case management coordinator helps to oversee

overall management of the patient, from the onset of the illness or injury into acute care hospitalization, specialized care

programs, and followup treatment.

Nonemergency weekend admission (by BLS). A process that reduces or denies coverage for nonemergency weekend admissions.

Preadmission certification (by BLS). An authorization given by a health care provider to a benefit recipient prior to hospitalization or before the delivery of certain health care benefits. Failure to obtain a preadmission certification in nonemergency

situations usually reduces or eliminates the health care provider’s obligation to pay for services rendered.

Preadmission testing. A plan benefit designed to encourage patients to obtain needed diagnostic services on an ambulatory basis

before a nonemergency hospital admission in order to reduce hospital length of stay.

Preventive care. Comprehensive care emphasizing priorities for prevention, early detection, and early treatment of conditions.

Preventive care generally includes routine physical examinations, immunization, and “well-person” care.

Retrospective review. A traditional form of utilization review. The patient’s chart is reviewed after the fact to determine whether

the treatment provided was medically necessary.

Second surgical opinion. A provision that encourages or requires participants to obtain the opinion of another doctor after a

physician has recommended that nonemergency or elective surgery be performed. Programs may be voluntary or mandatory in

that reimbursement is reduced or denied if the participant does not obtain the second opinion. Plans usually require that such

opinions be obtained from board-certified specialists with no personal or financial interest in the outcome.

Utilization management. A generic term for the preadmission certification, concurrent review, and retrospective review

techniques used to evaluate health care on the basis of appropriateness, necessity, and quality.

Utilization review. A cost-control mechanism for reviewing the appropriateness and the quality of care provided to patients.

Utilization review may come before (prospective), at the same time as (concurrent), or after (retroactive) services are rendered.
32 Compensation and Working Conditions Spring 2001

Table 1. Average monthly employee contribution, full-time employees, medium

and large private establishments,1 selected years, 1991-97

Individual coverage............................... $26.60 $31.55 $33.92 $39.14

Family coverage .................................. 96.97 107.42 118.33 130.07

Individual coverage............................... 25.84 31.48 32.91 41.69

Family coverage .................................. 91.52 102.48 112.18 132.37

Individual coverage............................... 29.23 31.77 36.18 34.28

Family coverage .................................. 118.19 121.84 132.66 125.79

1 Medium and large private establishments are those with 100 employees or more.

2 Non-HMO plans include traditional fee-for-service plans, preferred provider plans, and

exclusive provider plans.

1991 1993 1995 1997

All plans

Coverage type

Non-HMO plans2

HMO plans

Employer health care costs and

managed care

In recent decades, the United States

has experienced an overall rise in health

care expenditures and employer health

care costs.4 Trends and developments

in health care that affect employer-provided health care plans are a major concern, because most Americans receive

medical coverage through their jobs.5

The Employment Cost Index (ECI)

and the Employer Costs for Employee

Compensation (ECEC), both BLS surveys, have shown a rapid increase in

benefit costs since the early 1980s.6

According to the ECI, the rate of

growth in benefit costs has risen and

fallen at different times over the last

two decades. (See chart 1.) Peaking in

1983, it slowed in the mid-1980s, only

to rise sharply between 1987 and 1988.

Between 1989 and 1996, it decreased

again and leveled off thereafter. However, since early 1999, the percent

change in benefit costs has been rising again. Basically, the percent change

in benefit costs rose faster than the

percent change in the cost of wages

and salaries from 1982 to 1994. Over

the next 5 years, the change in benefit

costs was less than the percent change

in the cost of wages and salaries.

March 2001 ECEC data indicate that

27.1 percent of total employer costs for

employee compensation was benefit

costs. Health care costs accounted for

5.6 percent of compensation costs, a

greater share than most benefit costs.7

Unpublished data from the ECI show

that health care costs have driven overall benefit costs during the last two

decades. (See chart 2.) Like overall

benefit costs, these data for health care

in private industry peaked in the early

1980s, slowed during most of the 1990s,

and rose again in the late 1990s.8 9

According to the 1995 Report on

the American Workforce, the rapid increase in health care costs has had an

impact on employer-provided plans.10

As a result of employer cost concerns,

employees have seen a reduction in

coverage, an increase in their contributions towards plans, growth in the

availability of plans aimed at reducing

costs (managed care plans), and larger

numbers of managed care features

within plans.

As employees began paying higher

premiums for health care coverage, they

also began shifting toward plans that

restrict their choice of providers11 ; typically, these plans have lower premiums.12 However, employees who remained in plans that did not restrict the

choice of providers also saw an increased use of measures to limit plan

costs. Nevertheless, employee premiums have increased for all types of

plans. (See table 1.)

Since 1982, the EBS has provided

estimates of managed care plans and

plan features. The EBS has captured

data on the three types of plans that

are considered managed care—health

maintenance organizations, preferred

provider organizations, and exclusive

provider organizations13—as well as

traditional plans. The type of data collected on managed care features

throughout the years has varied considerably. For example, the EBS has

captured data on provisions for

preadmission testing, second surgical

opinions, hospital audits, nonemergency weekend admissions, and

preadmission certification. These data

have been expanded or limited by survey year, and the published estimates

reflect these changes.

To keep the survey current, BLS has

based changes in EBS survey design

primarily on emerging trends in health

care. For example, when health-care

costs increased in the 1980s, BLS responded by capturing details of cost

containment measures in the EBS.14 In

1982, BLS started publishing EBS estimates of the percent of covered workers in plans that required second surgical opinions; in 1985, other selected

managed care features, such as higher

reimbursement for generic prescription

drugs, were added; and, in the 1990s,

data on penalties for noncompliance

with the preadmission certification were

captured.

Managed care plans and features

Throughout the 1990s, more than 90

percent of full-time employees with

medical coverage were in plans with

managed care features. (See table 2.)

During this period, participation in traditional health care plans with managed

care features decreased, while participation in managed care plans increased.

These two approaches—traditional

plans with special features versus managed care plans—focus on different

ways of managing care.

Traditional fee-for-service plans. Participation in traditional fee-for-service

plans decreased in the mid-1990s from

66 percent of full-time employees with

medical care coverage in 1991 to 26

percent in 1997. This type of health

care plan pays incurred expenses for

specific medical procedures. Reim-
 Compensation and Working Conditions Spring 2001 33

Managed Care Plans and Features

82 85 88 91 94 97 00

-5

0

5

10

15

20

25

82 85 88 91 94 97 00

0

2

4

6

8

10

Chart 1.Twelve-month percent change in the Employment Cost Index for wages and salaries

and benefit costs, quarterly data, 1982-2000

Chart 2.Twelve-month percent change in the Employment Cost Index for total benefit costs and

health care costs, quarterly data, 1982-2000

12-month percent change

12-month percent change

Health benefit costs

Total benefit costs

Benefit costs

Wages and salaries
34 Compensation and Working Conditions Spring 2001

Table 2. Percent of full-time medical care participants with managed care

features by plan type, medium and large private establishments,1 selected years,

1991-97

 Managed care features by plan type 1991 1993 1995 1997

With managed care features ........................... 93 90 91 95

Traditional fee-for-service2 .......................... 59 40 28 21

Preferred provider organization ................... 16 26 34 40

Exclusive provider organization................... (3) 11 1

Prepaid health maintenance organization ...... 17 23 27 33

Without managed care features ....................... 7 10 9 5

Not determinable ........................................... – – – 1

1 Medium and large private establishments are those with 100 employees or more.

2 Traditional fee-for-service plans with managed care features.

3 Less than 0.5 percent.

NOTE: Because of rounding, sums of individual items may not equal totals. Dash

indicates no employees in this category.

bursements for these expenses are

made directly to health care providers

or to plan participants by the health

care plan, often a Blue Cross/Blue

Shield organization, or by the employer

who self-insures the plans.

In 1997, 21 percent of all full-time

employees with medical care coverage

were in traditional fee-for-service plans

with managed care features, down from

59 percent in 1991. (Five percent of all

full-time employees with medical care

coverage were in traditional plans without managed care features in 1997,

down slightly from seven percent in

199l.) Required preadmission certification and second surgical opinion were

the most prevalent managed care features used by these plans.

Preferred provider organizations

(PPOs). These plans are similar to traditional fee-for-service plans in that

participants’ incurred expenses are paid

after services are rendered. PPOs have

grown in popularity over the last decade. Forty percent of full-time health

care participants were enrolled in this

type of plan in 1997, up from sixteen

percent in 1991. (See table 2.) As in

traditional fee-for-service plans, participants can choose any health care provider, such as a hospital or physician,

but they receive higher benefits for

services rendered by designated providers. Participants who choose designated providers might have lower

annual deductibles, for example, or lower

catastrophic maximum limits than those

who select undesignated providers.

Health maintenance organizations

(HMOs). These plans provide a prescribed set of benefits to participants

for a prepaid fee. Typically, HMOs are

independent organizations that finance

and administer health care services.

These plans require the participant to

seek care only from specific care providers. Though restricted, most of the

health care services in these plans are

covered in full.

In 1997, 33 percent of participants

in health care plans were enrolled in

HMOs. These plans have programs

that arrange referral services, hospital

admissions, and other arrangements on

the participant’s behalf that are similar

to preadmission certification, concurrent review, and utilization review found

in non-HMOs. Through these programs, HMOs control cost while administering and monitoring the health

care of the patient.

By definition, HMOs include managed care features as part of their structure; the EBS, however, did not tabulate these features. (The EBS published

data on managed care features only for

traditional fee-for-service plans in 1991.

In 1993, the EBS expanded its publication of such features to cover all nonHMO plans.) Nearly all HMOs have

hospital admissions and referral services policies. In HMOs, participants

select a primary care physician who

acts as their health care gatekeeper.

These physicians arrange hospitalizations on the patient’s behalf and coordinate other treatments as needed.

Managed care features: penalties

for noncompliance

Traditionally, the EBS captured managed care features that were triggered

by the participant, and not by the provider. Participants in plans with managed care features could incur a penalty by choosing not to follow managed

care rules. For example, some plans

have arrangements with the provider

to obtain a preadmission certification;

participant noncompliance may result

in a reduction in benefits. The most

prominent managed care features captured by the EBS that have participant

penalties were second surgical opinions and preadmission certification.

(See table 3 for the percent of non-HMO

participants in plans with specified

managed care features.)

In 1997, 50 percent of non-HMO

participants had a provision for second surgical opinion; 18 percent of

those had a penalty for noncompliance.15 A typical penalty might be a

reduction of the coinsurance for a surgery, with the plan paying benefits at

50 percent rather than 80 percent, or

the imposition of a deductible for the

surgery, if a second opinion was not

obtained.

Three out of five full-time medical

care plan participants in non-HMOs—

traditional fee-for-service plans, preferred provider organizations, and exclusive provider organizations—were

required to get preadmission certification. Typically, plans reduce benefits

if participants fail to obtain a preadmission certification. A penalty, such as

reduced coinsurance or an added deductible, could apply to those not obtaining the certification. Preadmission

certification has become the most prominent managed care feature in non-HMO

plans for which data are captured by

the EBS. Specific details for preadmission certification penalties have been

published only since 1993. (See table 4).
 Compensation and Working Conditions Spring 2001 35

Managed Care Plans and Features

Table 3. Percent of full-time medical care participants in non-HMO plans by

managed care features, medium and large private establishments,1 selected

years, 1993-97

Managed care feature 1993 1995 1997

Preadmission certification .............................. 74 65 59

Second surgical opinion................................. 75 53 50

Preadmission testing..................................... 51 42 42

Utilization and concurrent review .................... 42 38 34

Nonemergency weekend admission ................ 14 10 11

Hospital bill audit .......................................... 14 7 8

Other ......................................................... – (2) 1

1 Medium and large private establishments are those with 100 employees or more.

2 Less than 0.5 percent.

NOTE: Dash indicates no employees in this category.

Table 4. Percent of full-time medical care participants in non-HMO plans with

preadmission certification penalties, medium and large private establishments,1

selected years, 1993-97

Preadmission certification penalty 1993 1995 1997

With penalty ................................................ 97 96 97

Reduced coinsurance2 ............................. 44 37 37

Separate deductible for hospital admission ... 35 34 38

No benefit ............................................... 5 4 3

Combination of separate deductible and

 reduced coinsurance .............................. 2 2 2

Other ..................................................... 3 4 3

Penalty not determinable3 .......................... 8 14 14

Without penalty ............................................ 3 4 3

1 Medium and large private establishments are those with 100 employees or more.

2 In 1993 and 1995, selected coinsurance penalties were identified.

3 In these cases there is a penalty, but the type is not identified.

NOTE: Because of rounding, sums of individual items may not equal totals.

In 1997, 97 percent of non-HMO

participants in plans with a preadmission certification feature were subject

to penalties for not obtaining the certification. Many of them had to pay a

separate deductible in such circumstances. For example, some participants might have to pay a $300 deductible per admission before plan benefits

begin. However, other participants had

a reduced coinsurance benefit if the

hospitalization was not certified, and

a few lost all benefits in such cases.

The major forms of penalties for noncompliance with preadmission certification requirements have remained

consistent over the past decade. In

1993, 1995, and 1997, the most frequently observed penalties were a reduced coinsurance or a separate hospital deductible.

Managed care and the NCS

In 1996, BLS introduced the National

Compensation Survey (NCS).16 The

EBS is in the final phase of full integration into the NCS. The two major differences between the NCS and the EBS

in the area of managed care are the expansion of managed care plan types

and the reduction in the types of managed care features collected.

Managed care plans. Point-of-service

plans are a type of HMO plan that allows enrollees to receive services outside the network at a higher cost. These

plans operate as HMOs do: participants have to elect a primary care physician to coordinate their care. Nineteen percent of all HMO participants

were in plans with point-of-service features in 1997. In the health care field,

there has been a recent trend toward

identifying a point-of-service option as

a separate plan type or considering

such plans to be PPOs. Nevertheless,

the EBS has always classified these

plans as HMOs, and the NCS will continue to do so. Beginning in 2001, the

NCS will expand publication of the data

available on HMOs to reflect this recent trend by dividing HMOs into two

categories: traditional HMOs and

point-of-service HMOs.

This division of HMOs into two categories will allow more detailed analysis and comparisons among plan characteristics and premiums. For example,

NCS data should answer questions

such as: are employees’ plan premiums

higher for point-of-service HMOs than

for traditional HMOs? And, how do

plan provisions differ among managed

care plans? The NCS data also will allow further comparisons among plan

types and provisions, such as physician office visits and prescription drug

copayments.

Managed care features. BLS evaluated plan documents provided by respondents to determine how well they

described managed care features.17

The main objective of this evaluation

was to determine how the NCS should

proceed regarding the collection and

publication of managed care features.

As expected, plan documents in most

cases described various managed care

features, such as preadmission certification, medical case management, retrospective review, and concurrent review. Descriptions of managed care

features were inconsistent among the

plan documents evaluated. Two plans

may use the same name or label to describe different features, or different

names to describe the same feature.

(One example of this latter case might

be “concurrent review” and “utilization

review.”) In addition, plan documents

were inconsistent in the types of managed care benefits described. These

reasons, among others, prompted BLS

to streamline the managed care features

that NCS will collect. The plan documents—the main source of provision

data—are not a reliable source of man-
36 Compensation and Working Conditions Spring 2001

aged care descriptions and definitions.

The NCS will collect detailed information on only two managed care features—preadmission certification,

which remains the most frequent managed care feature used, and utilization

review. Even though utilization review

was the fourth most prominent feature

in 1997, the NCS will continue to capture this feature because it functions

as the care monitor once the patient is

admitted to the hospital.18

Conclusion

The NCS data will allow comparisons

between benefit provisions and costs

because all data will reside on a single

database.19 The NCS will continue to

monitor the health care industry and

expects to capture future developments

in managed care plans and features.

Because of the flexible design of the

NCS, changes will be incorporated into

the survey as BLS strives to produce

the most relevant and accurate data

available.

1

 See Source Book of Health Insurance

Data, 1999-2000 (Washington, Health Insurance Association of America, 1999), p.

52. 2

 The Employee Benefits Survey (EBS)

was an annual survey that covered the incidence and provisions of employee benefit

plans. BLS published data from this survey

from 1979 to 1998. 3

 For prior articles on this or similar topics, see Thomas P. Burke and Rita S. Jain,

“Trends in employer-provided health care

benefits,” Monthly Labor Review, February

1991, pp. 24-30; Stephanie L. Hyland,

“Health care benefits show cost containment

strategies,” Monthly Labor Review, February

1992, pp. 42-43; Thomas P. Burke, “Alternatives to hospital care under employee benefit plans,” Monthly Labor Review, December 1991, pp. 9-15; and Robert B. Grant,

“Outpatient surgery: helping to contain

health care costs,” Monthly Labor Review,

November 1992, pp. 33-36. These articles

all are reprinted in Employee Benefits Survey: A BLS Reader, Bulletin 2459 (Bureau of

Labor Statistics, February 1995). 4 For more information, see Hilery

Simpson, “Are Health Industry Compensation Costs a Factor Influencing Employer

Health Care Costs?” Compensation and Working Conditions, winter 1997, pp. 3-11. 5

 See “Health Care and the Workplace:

Recent Trends and Current Status,” Report

on the American Workforce, 1995 (Washington, U.S. Department of Labor, 1995), ch. 3. 6

 The Employment Cost Index (ECI) is a

measure of the change in the cost of labor,

free from the influence of employment shifts

among occupations and industries. The compensation series includes changes in wages

and salaries and employer costs for employee

benefits. The wage and salary series and the

benefit cost series provide the changes for

the two components of compensation.

The Employer Costs for Employee Compensation (ECEC) program measures the

average cost per employee hour worked that

employers pay for wages and salaries and benefits.

For more information about the ECI and

the ECEC, see the BLS Web site at http://

stats.bls.gov/ncs/ect. 7

 The most costly benefit components

were legally required benefits, such as Social

Security, and paid leave, such as vacations.

These benefits accounted for 8.3 and 6.6

percent, respectively, of the total employer

costs for employee compensation. 8

 The 12-month percent changes in employer costs per hour worked for health care

in private industries from the ECI are not

published as part of official estimates for

various reasons: (1) variances are not calculated for the estimates; (2) there are fewer

observations supporting these estimates than

there are for total estimates; (3) the employer nonresponse rate is substantial; and

(4) employers sometimes report a combined

cost for various benefits including health care,

and such combined costs are allocated by BLS

to the individual benefits. 9

 From 1980 to 1998, the percent change

in health insurance costs increased over 3

times as much as the percent change in wages

and salaries, and nearly 3 times as much as

the percent change in other ECI benefits.

See Albert E. Schwenk, “Trends in Health

Insurance Costs,” Compensation and Working Conditions, December 1996, pp. 31-33;

and Albert E. Schwenk, “Trends in Health

Insurance Costs,” Compensation and Working Conditions, spring 1999, pp. 24-28. 10 See “Reactions to Rising Health Care

Costs,” Report on the American Workforce,

1995 (Washington, U.S. Department of Labor, 1995), p. 110. 11 For a comparison of the rise of employee medical care contributions and the

rate of inflation, see Allan P. Blostin and

Jordan N. Pfuntner, “Employee Medical Care

Contributions on the Rise,” Compensation

and Working Conditions, spring 1998, pp.

46-51. 12 According to the KPMG Survey of Employer-Sponsored Health Benefits in 1998,

traditional plans required larger premiums for

single and family coverage than did HMOs

and PPOs. In 1998, conventional plans averaged annual premiums of $2,280 for single

coverage and $5,832 for family coverage. In

the same year, the average annual premium

for single coverage for HMOs and PPOs was

$1,920 and $2,100, respectively, while the

average annual premium for family coverage

was $5,280 and $5,604, respectively. See

Jon Gabel and Kimberly Hurst, “Health Benefits in 1998,” KPMG Survey of EmployerSponsored Health Benefits in 1998 (KPMG

Peat Marwick LLP, June 1998), p. 13. 13 Exclusive provider organizations are

groups that contract to provide comprehensive medical services. These plans are a type

of fee-for-service plan that requires participants to use plan providers to receive coverage. There is no coverage for care received

from a non-network provider. 14 The International Foundation of Employee Benefits defines cost containment as

“activities aimed at holding down the cost of

medical care or reducing its rate of increase,”

according to Employee Benefit Plans: A Glossary of Terms, 9th edition (Brookfield, WI,

International Foundation of Employee Benefits, 1997), p. 36. For more information

on employer containment of health insurance costs, plan types, and cost containment

features, see John J. Kane, Allan P. Blostin,

and Jordan N. Pfuntner, “Changing Survey

Strategies in the Evolution of Health Care

Plans,” Compensation and Working Conditions, September 1996, pp. 3-10.

15 For more information, see Employee

Benefits in Medium and Large Private Establishments, 1997, Bulletin 2517 (Bureau

of Labor Statistics, 1999), table 73, p. 65. 16 The National Compensation Survey

produces comprehensive compensation data.

It combines data previously published by four

separate programs—Occupational Compensation Program, Employment Cost Index,

Employer Costs for Employee Compensation, and Employee Benefits Survey. 17 Respondents provide BLS with what is

known as summary plan descriptions. These

plan documents detail plan provisions and

participants’ responsibilities. 18 The NCS will not capture data on second surgical opinion provisions. These provisions are becoming less relevant in medical

care plans because patients are not required

to follow the advice of the second opinion.

In addition, some plan documents are not as

detailed as others in terms of managed care

features. Still other plans might combine

second surgical opinions with the regular

preadmission certification process. For more

information, see Allan P. Blostin and Iris S.

Díaz, “Health Insurance Provisions Captured

by the EBS and the NCS,” Compensation and

Working Conditions, spring 1999, p. 16. 19 Having all data in one database will allow the publication of more estimates. This

does not imply that every element collected

will be published, however. The BLS assures

a high degree of voluntary cooperation by

keeping confidentiality agreements. Data

are combined and released in summary tables,

analyses, and reports. For more information

on BLS survey procedures, see BLS Handbook of Methods, Bulletin 2490 (Bureau of

Labor Statistics, April 1997), pp. 1-2.