Lo Sasso A T, Freund D A
Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Illinois 60208, USA.
Med Care. 2000 Sep;38(9):937-47. doi: 10.1097/00005650-200009000-00007.
We examined the differential effect of Medicaid managed care (MMC) among Aid to Families With Dependent Children (AFDC) and Supplemental Security Income (SSI) enrollees over time by comparing the experiences of adult nonelderly enrollees in the Health Plan of San Mateo in California versus Ventura County's fee-for-service (FFS) enrollees.
Four years of administrative claims data were used to construct a longitudinal data set and estimate panel data models to decompose the effect of managed care over time.
AFDC MMC enrollees exhibited generally fewer ambulatory visits, lower expenditures, and higher monthly probabilities of a preventable hospitalization relative to comparably enrolled FFS patients. SSI MMC enrollees had more emergency department visits and higher monthly probabilities of hospitalization. However, SSI MMC enrollees had more ambulatory visits and more medications during the first year of enrollment relative to SSI FFS enrollees, although levels were similar in subsequent years. SSI MMC enrollees did not exhibit a significantly higher level of expenditures in the first year of enrollment, although in subsequent years, expenditure levels were significantly lower.
The results for emergency department visits and preventable hospitalizations presented a decidedly downbeat picture of access to care for AFDC and SSI enrollees in MMC. However, some aspects of utilization under managed care exhibited results consistent with long-term- oriented treatment for enrollees with a greater likelihood of remaining in the system for a longer period of time (SSI enrollees). By contrast, enrollees more likely to be enrolled for shorter periods (AFDC enrollees) tended to exhibit care patterns under MMC consistent with lower levels of care relative to FFS.
通过比较加利福尼亚州圣马特奥健康计划中的成年非老年参保者与文图拉县按服务收费（FFS）参保者的经历，我们研究了随着时间推移医疗补助管理式医疗（MMC）对有受抚养子女家庭援助（AFDC）和补充保障收入（SSI）参保者的不同影响。
利用四年的行政索赔数据构建纵向数据集，并估计面板数据模型以分解管理式医疗随时间的影响。
与参保情况相似的FFS患者相比，AFDC的MMC参保者门诊就诊次数总体较少、支出较低，且可预防住院的月度概率较高。SSI的MMC参保者急诊就诊次数更多，住院月度概率更高。然而，与SSI的FFS参保者相比，SSI的MMC参保者在参保第一年的门诊就诊次数更多，用药也更多，尽管后续年份的水平相似。SSI的MMC参保者在参保第一年的支出水平并未显著更高，尽管在后续年份，支出水平显著更低。
急诊就诊和可预防住院的结果显示，MMC中AFDC和SSI参保者获得医疗服务的情况明显不容乐观。然而，管理式医疗下的一些利用情况结果与对更有可能在系统中停留更长时间的参保者（SSI参保者）进行长期治疗一致。相比之下，更有可能短期参保的参保者（AFDC参保者）在MMC下的护理模式往往显示相对于FFS护理水平较低。
