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

Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA.
American Journal of Public Health (Impact Factor: 4.23). 11/2010; 100(11):2235-40. DOI: 10.2105/AJPH.2009.182451
Source: PubMed

ABSTRACT 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.
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.
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).
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.

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