The relation between managed care market share and the treatment of elderly fee-for-service patients with myocardial infarction

Abstract

Medicare beneficiaries with fee-for-service insurance who resided in areas with high managed care activity were more likely to have received appropriate treatment with beta-blockers and aspirin, and less likely to have undergone coronary angiography following admission for myocardial infarction. Thus, the effects of managed care may not be limited to managed care enrollees.

Medicare Managed Care Spillovers and Treatment Intensity

“…15 Prior evidence on the effect of managed care penetration on the health of FFS beneficiaries has been equivocal (Bundorf et al, 2004;Escarce et al, 2006;Kessler and McClellan 2000;Mukamel et al, 2001). 16 The results in Table V indicate that increased MA penetration has no effect on inpatient mortality for those enrolled in an MA plan but is associated with a small increase in mortality for both FFS Medicare patients and, 13 Note that neither Heidenreich et al (2002) nor Bundorf et al (2004) adjust for the potential endogeneity of MA penetration. 14 One potential explanation for the discrepancy between PTCI and CABG spillovers relates to the observed levels of overuse for each procedure.…”

Use of Preventive Services by Medicare Fee-For-Service Beneficiaries

“…To retain comparability with other studies we created categories that reflected low (Ͻ10%), moderate (10 -29.99%), and high (Ն30%) levels of MCA. 15,20 Covariates Demographic variables were retrieved from the Denominator file. Individuals were characterized using age groups (65-69; 70 -74; 75-79; 80 -84; and 85ϩ years), racial categories (white, black, and other), and gender.…”

“…9,15,20 In these models, introduction and expansion of managed care into a market may influence the behavior of health care providers with these behavioral effects "spilling over" to patients with other forms of insurance coverage.…”

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

“…While there is suggestive evidence that greater area-level managed care penetration (the share of the insured population enrolled in managed care) leads to lower spending and potentially higher quality for other patients in the area, it is difficult to isolate these effects: areas with higher enrollment in managed care (Medicare or otherwise) may have patients with different characteristics that also affect health-care utilization (Chernew, DeCicca, and Town 2008; Heidenreich et al 2002; Bundorf et al 2004). For example, MA plans may choose to locate or expand in areas with high FFS spending because they believe they can capture larger gains to improved efficiency there.…”