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Am J Public Health. 2010 Nov;100(11):2235-40. doi: 10.2105/AJPH.2009.182451. Epub 2010 Sep 23.

Unhealthy competition: consequences of health plan choice in California Medicaid.

Author information

  • 1Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA. c.millett@imperial.ac.uk

Abstract

OBJECTIVES:

We compared the quality of care received by managed care Medicaid beneficiaries in counties with a choice of health plans and counties with no choice.

METHODS:

This cross-sectional study among California Medicaid beneficiaries was conducted during 2002. We used a multivariate Poisson model to calculate adjusted rates of hospital admissions for ambulatory care-sensitive conditions by duration of plan enrollment.

RESULTS:

Among beneficiaries with continuous Medicaid coverage, the percentage with 12 months of continuous enrollment in a health plan was significantly lower in counties with a choice of plans than in counties with no choice (79.2% vs 95.2%; P < .001). Annual ambulatory care-sensitive admission rates adjusted for age, gender, and race/ethnicity were significantly higher among beneficiaries living in counties with a choice of plans (6.58 admissions per 1000 beneficiaries; 95% confidence interval [CI] = 6.57, 6.58) than among those in counties with no choice (6.27 per 1000; 95% CI = 6.27, 6.28).

CONCLUSIONS:

Potential benefits of health plan choice may be undermined by transaction costs of delayed enrollment, which may increase the probability of hospitalization for ambulatory care-sensitive conditions.

PMID:
20864718
[PubMed - indexed for MEDLINE]
PMCID:
PMC2951930
Free PMC Article

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