The Wharton School, University of Pennsylvania, Philadelphia, PA, USA.
J Policy Anal Manage. 2013;32(3):505-35. doi: 10.1002/pam.21693.
From 1991 to 2009, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 71 percent. This increase was largely driven by state and local mandates that required most Medicaid recipients to enroll in an MMC plan. Theoretically, it is ambiguous whether the shift from fee-for-service into managed care would lead to an increase or a reduction in Medicaid spending. This paper investigates this effect using a data set on state- and local-level MMC mandates and detailed data from the Centers for Medicare and Medicaid Services (CMS) on state Medicaid expenditures. The findings suggest that shifting Medicaid recipients from fee-for-service into MMC did not on average reduce Medicaid spending. If anything, our results suggest that the shift to MMC increased Medicaid spending and that this effect was especially present for risk-based HMOs. However, the effects of the shift to MMC on Medicaid spending varied significantly across states as a function of the generosity of the state's baseline Medicaid provider reimbursement rates.
从 1991 年到 2009 年，参加 HMO 和其他形式的医疗补助管理式医疗（MMC）的医疗补助受助人的比例从 11%增加到 71%。这种增长主要是由州和地方的规定推动的，这些规定要求大多数医疗补助受助人参加 MMC 计划。从理论上讲，从按服务收费向管理式医疗的转变是否会导致医疗补助支出的增加或减少尚不清楚。本文利用关于州和地方层面 MMC 规定的数据组以及医疗保险和医疗补助服务中心（CMS）关于州医疗补助支出的详细数据，调查了这种影响。研究结果表明，将医疗补助受助人从按服务收费转为 MMC 平均不会减少医疗补助支出。如果有的话，我们的结果表明，向 MMC 的转变增加了医疗补助支出，而这种影响在基于风险的 HMO 中尤为明显。然而，作为州基线医疗补助提供者报销率慷慨程度的函数，向 MMC 的转变对医疗补助支出的影响在各州之间存在显著差异。
