National Estimates of the Effects of Mandatory Medicaid Managed Care Programs on Health Care Access and Use, 1997–1999

Garrett, Bowen; Zuckerman, Stephen

doi:10.1097/01.mlr.0000167105.75204.71

Cited by 30 publications

(31 citation statements)

References 6 publications

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“…a bigger increase in physicians' financial incentives to perform C-sections. 36 The finding that the effect of switching from FFS to MMC on C-section use is correlated with reimbursement prices would be consistent with the conclusion that switching from FFS to MMC affects C-section use by changing providers' financial incentives to perform C-sections. If the positive association between switching from FFS to MMC and C-section use is driven by a change in physician reimbursement prices, it could help explain the differences between this and previous studies.…”

supporting

confidence: 62%

“…I compute the HHI as the sum of squared HMO shares of all hospital discharges within a HRA to measure HMO concentration at the market (HRA) level. 36 For notational simplicity, I refer to the HHI of all HMO discharges at the market level as "market level HHI." To my knowledge, I am the first to use the patient insurance information contained in the OSHPD discharge data to create a measure of HMO market structure.…”

mentioning

confidence: 99%

“…As California could have chosen counties for this purpose, as many other states did, and elected to form these new rating areas it is arguable that rating areas are a preferable definition of a geographic insurance market. 36 As premium pricing decisions may be influenced by competition for all types of patients (not just birth patients), I calculate the HHI for all discharges at the market level.…”

mentioning

confidence: 99%

“…However, both the positive effect of switching from FFS to MMC and the evidence that this positive effect varies with the level of physician concentration in the switching counties are consistent with the reimbursement price explanation. 36 One potential concern could be that this result is driven by changes in hospital HHI that is unrelated to the switch from FFS to MMC. To consider this possibility, I estimate whether hospital HHI had a different effect in control (FFS) counties before and after the treatment counties switched from FFS to MMC (Table 3.4, column 2).…”

mentioning

confidence: 99%

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Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Johnson

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The United States health care system has garnered significant policy attention in recent years. The importance of the health care system is in part a fiscal concern, but also because of the role it plays in peoples' lives. In many cases, patients' lives greatly depend on the quality of the health care they receive. The organization of the health care system has undergone many dramatic changes in recent years and it is important to understand how these changes impacted the way the health care system functions. The effects of the various changes on health care spending and, in particular, on patient treatment outcomes remain poorly understood. In this dissertation, I investigate how three recent trends in the organization of the U.S. health care system have impacted the treatments that patients receive: the decrease in health insurer competition, the increase in hospital-physician integration, and the use of managed care in public insurance programs.In Chapter 1, I study whether health insurer competition increases the use of costly treatments. Health insurers have an incentive to influence health care providers' treatment decisions to reduce their own reimbursement costs. If a single insurer is effective at inducing a provider to use less costly treatments, the provider may do so for patients of other insurers. While an insurer can reduce their own costs, spillover of their cost reduction can allow rival insurers to also benefit. I develop a theoretical framework demonstrating how competition can deter insurers from limiting costly treatments due to provider-level spillover concerns. I empirically test the relationship between Health Maintenance Organization (HMO) competition and Cesarean section (C-section) use. C-sections are a costly treatment that HMOs have an incentive and the potential ability to influence. I argue that HMOs' return to limiting C-sections should be lower at hospitals that contract with more HMOs due to potential spillover. I find that patients are more likely to receive C-sections at hospitals with lower HMO concentration -where spillover poses a greater deterrent to HMO cost reduction. The magnitude of this effect increases with the level of HMO competition in the market containing the hospital. Taken together, these results provide evidence that HMO competition can increase the use of C-sections at hospitals that contract with multiple HMOs.ii In Chapter 2, I study whether hospital-physician integration affects health care utilization by altering the treatments patient receive. I estimate the effect of hospitalphysician integration on the use of C-sections in childbirth using a sample of privately insured patients from California over 2005-2012. Childbirth is a convenient treatment setting to study utilization because it presents a binary choice between a high intensity, high cost procedure (C-section) and a comparatively low intensity, low cost alternative (vaginal birth). I am able to decompose the effect of hospital-physician integration on C-section use by the form of integra...

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supporting

confidence: 62%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Johnson

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“…1 Policies vary across states, with some relying more on primary care case management (PCCM) and others using health maintenance organizations (HMOs). In PCCM, primary care providers receive a monthly fee for coordinating medical services but still collect fee-for-service (FFS) reimbursement.…”

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confidence: 99%

Does Medicaid Managed Care Affect Access To Care For The Uninsured?

Haberer

Garrett²,

Baker

2005

Health Affairs

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This study investigates whether the implementation of Medicaid managed care from 1994 to 2001 was associated with changes in access to care for the uninsured. We used regression analysis to examine relationships between changes in county-level Medicaid managed care activity over time and changes in four measures of perceived access to care. After we controlled for sex, race, ethnicity, poverty, age, health, and education and included county fixed effects to account for unobserved county characteristics that are potentially associated with the implementation of Medicaid managed care and outcome measures, we found that Medicaid managed care has had no consistent effect on access.

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Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

Herring

Adams

2011

Health Econ.

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States have increasingly used Health Maintenance Organizations (HMOs) to provide medical services to the Medicaid population. However, the effects of these initiatives on total health-care expenses, the mix of utilization, and access to care remain unclear. We examine the effect of changes in Medicaid HMO penetration between 1996 and 2002 on these outcomes using data for the nonelderly Medicaid population in the Community Tracking Study's Household Survey. We develop market-level measures of Medicaid HMO penetration from CMS and InterStudy data, distinguish whether the HMOs specialize in serving the Medicaid population, and use a market fixed-effects model to focus on changes in HMO penetration rates over time. Although limited by imprecise estimates, we find some evidence that utilization and access are related to the market penetration rates of commercial and Medicaid-dominant HMOs, but the pattern of results we observe does not appear to be consistent with welfare improvements.

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National Estimates of the Effects of Mandatory Medicaid Managed Care Programs on Health Care Access and Use, 1997–1999

Cited by 30 publications

References 6 publications

Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Essays on the Effects of Health Insurer and Health Care Provider Organization on Patient Treatments

Does Medicaid Managed Care Affect Access To Care For The Uninsured?

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

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