Medicare Payments and System-Level Health-Care Use: The Spillover Effects of Medicare Managed Care

Baicker, Katherine; Robbins, Jacob A.

doi:10.1162/ajhe_a_00024

Cited by 43 publications

(42 citation statements)

References 45 publications

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“…Studies presenting identical clinical vignettes to physicians in different geographic areas found that responses about treatment choices were associated with regional health care use, 20–22 underscoring the link between physician behavior and small area variations. In addition, studies 23–27 from the spillover literature support the idea that physicians may have a single-practice style that they apply to similar types of patients, regardless of insurance status.…”

Section: Discussionmentioning

confidence: 96%

Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

et al. 2016

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Section: Discussionmentioning

confidence: 96%

Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

et al. 2016

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“…This finding, while surprising at first blush, is consistent with a sizable body of health economics research suggesting that policy adoption in one payer may have spillover effects among other payers. 20–22 One likely mechanism for such spillover effects is that Medicaid payment policies may drive practice pattern norms, and physicians are likely to provide similar care to all patients regardless of payer. 23 It follows that coverage of medically necessary abortion in Medicaid may affect provision of abortion services among women with both Medicaid and private insurance.…”

Section: Discussionmentioning

confidence: 99%

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality

Jarlenski

Hutcheon

Bodnar

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To estimate the association between state Medicaid coverage of medically necessary abortion and severe maternal morbidity and in-hospital maternal mortality in the U.S. Methods We used data on pregnancy-related hospitalizations from the Nationwide Inpatient Sample from 2000 to 2011 (weighted n=38,016,845). State-level Medicaid coverage of medically necessary abortion for each year was determined from Guttmacher Institute reports. We used multivariable logistic regression to examine the association between state Medicaid coverage of abortion and severe maternal morbidity and in-hospital maternal mortality, overall and stratified by payer. Results The unadjusted rate of severe maternal morbidity was lower among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such coverage (62.4 vs. 69.3 per 10,000). Among Medicaid-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, there were 8.5 per 10,000 fewer cases (95% CI 4.0,16.5) of severe maternal morbidity in adjusted analyses, relative to those in states without such Medicaid coverage. Similarly, there were 10.3 per 10,000 fewer cases (95% CI 3.5,17.2) of severe maternal morbidity in adjusted analyses among private insurance-paid hospitalizations in states with Medicaid coverage of medically necessary abortion, relative to those in states without such Medicaid coverage. The adjusted rate of in-hospital maternal mortality was not different for Medicaid-paid hospitalizations in states with and without Medicaid coverage of medically necessary abortion (9.2 and 9.0 per 100,000, respectively), nor for private-insurance paid hospitalizations (5.6 and 6.1 per 100,000, respectively). Conclusions State Medicaid coverage of medically necessary abortion was associated with an average 16% decreased risk of severe maternal morbidity. An association between state Medicaid coverage of medically necessary abortion and a reduced risk of severe maternal morbidity was observed in women covered by both Medicaid and private insurance. Results suggest that Medicaid coverage of medically necessary abortion is not harmful to maternal health.

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“…A secondary outcome was receipt of life‐sustaining treatment on subsequent admission (Table S2) . Mortality, defined as patient death occurring greater than 30 days from the index operation, was obtained from the SAF Denominator file . Inpatient, outpatient, and hospice expenditures were price standardized and adjusted by wage index, Disproportionate Share Hospital and Indirect Medical Education .…”

Section: Methodsmentioning

confidence: 99%

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

Paredes

Hyer

Tsilimigras

et al. 2019

Journal of Surgical Oncology

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Background: Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. Methods: Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. Results: Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) Conclusion: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.

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Medicare Payments and System-Level Health-Care Use: The Spillover Effects of Medicare Managed Care

Cited by 43 publications

References 45 publications

Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

Comparison of Low-Value Care in Medicaid vs Commercially Insured Populations

State Medicaid Coverage of Medically Necessary Abortions and Severe Maternal Morbidity and Maternal Mortality

Hospice utilization among Medicare beneficiaries dying from pancreatic cancer

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