Maciejewski M, Hebert P, McBean M, Dowd B; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Matthew Maciejewski, PhD, Northwest Center for Outcomes Research in Older Adults, VA Health Services Research and Development Service and University of Washington School of Public Health, HSR&D (152), VAPSHCS, 1660 S. Columbian Way, Seattle, WA 98108. Tel: 206-764-2445. Fax: 206-764-2935. E-mail: mlmaciej@u.washington.edu
Research Objective: This paper examines the relationship between HMO market penetration and the provision of high-cost inpatient services and outpatient care appropriate for elderly Medicare beneficiaries with diabetes enrolled in fee-for-service (FFS) plans. This study extends previous research on the spillover effect of HMOs on the FFS sector by considering specific inpatient and outpatient services provided to a chronically ill population.Study Design: Data from the 1994 Medicare Provider and Analysis Review (MEDPAR) File are used to identify FFS beneficiaries with diabetes. 1995 HMO penetration rates in the under-65 market are based on Interstudy data, patient characteristics are based on Medicare data, and market area characteristics are based on the Area Resource File. The factors associated with hospitalization, emergency room use, MRI use, cardiology and nephrology visits, as well as provision of HbA1c, annual eye exams, and HDL tests are estimated with logistic regressions corrected for clustering at the county level. Independent variables include the beneficiary's age, diabetic complications, HMO market penetration rate, racial and income characteristics of the county, and regional fixed effects. The unit of analysis is the individual Medicare beneficiary.Population Studied: A random sample of 130,792 elderly Medicare beneficiaries with diagnosed diabetes in the FFS sector in 1994.Principal Findings: Increases in HMO market penetration were associated with decreases in the probability of hospitalization and MRI use. For outpatient services, increased HMO market penetration was associated with increases in the probability of a visit to a cardiologist, a visit to a nephrologist, and the provision of HDL tests. Conclusions: This study provides evidence that HMOs have a spillover effect on the care provided to FFS Medicare beneficiaries with diabetes, controlling for patient and market characteristics. The benefits to beneficiaries in Medicare FFS plans include a reduction in expensive inpatient services and an increase in outpatient care appropriate for people with diabetes. Implications for Policy, Delivery or Practice: As Medicare introduces Medicare+Choice and other managed care options to beneficiaries, the care provided to vulnerable populations should be tracked to ensure that appropriate care continues to be provided in both FFS and managed care plans. FFS plans and providers caring for Medicare patients with diabetes may provide more effective care by adopting select managed care practices.Primary Funding Source: Centers for Disease Control and Prevention
Publication Types:
Keywords:
- Adoption
- Aged
- Ambulatory Care
- Diabetes Mellitus
- Fee-for-Service Plans
- Health Maintenance Organizations
- Hospitalization
- Humans
- Logistic Models
- Managed Care Programs
- Medicare
- Medicare Part C
- economics
- hsrmtgs
Other ID:
UI: 102272483
From Meeting Abstracts