Abstract
BackgroundThe intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations.MethodsThe study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care.ResultsThe results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant.ConclusionsThe results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients.
Highlights
The intent of adopting managed care plans is to improve access to health care services while containing costs
Medicaid beneficiaries residing in Florida counties had three Medicaid managed care plans from which to choose
We found that patients in counties with higher Primary care physician (PCP) and Non-physician clinician (NPC) ratios were less likely to be admitted for Ambulatory care sensitive condition (ACSC)
Summary
The intent of adopting managed care plans is to improve access to health care services while containing costs. In 1984, in order to slow the rate of growth of Medicaid expenditures, Florida adopted Medicaid managed care (MMC) program options such as Health Maintenance Organizations (HMOs) and Provider Service Networks (PSNs). The Agency for Health Care Administration (AHCA) has primary responsibility for Florida’s Medicaid program and has contracted with HMOs on a prepaid fixed monthly rate per member since 1984. In order to expand Medicaid managed care choices, Florida implemented the Medicaid Provider Access System (MediPass) in 1991. In 2008, Medicaid HMOs, MediPass, and Medicaid PSNs accounted for approximately 46%, 54%, and 1% of total Medicaid managed care enrollments, respectively. Florida Medicaid recipients have at least 15 different managed care program options in Medicaid and more than two-thirds (i.e., about 1.9 million) of all Florida Medicaid recipients were enrolled in one of the managed care programs [7,8]
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