Wolfson G; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Gabriela Wolfson, M. P. A., Ph.D. Student and Research Assistant, Martin School of Public Policy and Administration, University of Kentucky, 415 Patterson Office Tower, Lexington, KY 40506. Tel: 606-257-6000; Fax: 606-323-1937; e-mail: gdwolf0@pop.uky.edu
Research Objective: As providers and health plans merge at an unprecedented rate, increased concern has developed among antirust agencies concerning the impact of consolidation on health care markets. There is some evidence that horizontal consolidation strategies may negatively affect access and continuity of health care. This poster presentation presents findings concerning the impact of different types of mergers and acquisitions in health care on Medicaid managed care beneficiaries by assessing pre- and post- merger access and continuity of care. Beneficiary satisfaction with merged plans and providers is also addressed.Study Design: The theoretical premise for this project is drawn from related cost function studies. First, recent mergers among health plans identified as participating in Medicaid managed care and providers serving a large proportion of Medicaid managed care beneficiaries were isolated in three states with high HMO penetration. Second, enrollment data incorporating pre- and post- merger beneficiary characteristics for 5,000 Medicaid managed care beneficiaries were obtained from three state Medicaid agencies over time, providing measures for access to and continuity of care. Difference between means tests were preformed to determine pre- and post- merger differences pertaining to access and continuity of care, and an ordinary least squares model was estimated to net out the effects of type of merger on access controlling for individual patient characteristics and type of merger (horizontal versus vertical). Continuity of care was estimated via a probit model with explanatory variables selected to control for provider, plan, and patient characteristics. Finally, one state's Medicaid database was used to examine beneficiary satisfaction with Medicaid managed care after merger.Population Studied: 5,000 Medicaid managed care plan beneficiaries in three states. Principal Findings: Controlling for individual characteristics among providers, plans, and patients, access to care was significantly associated with type of merger, with decreased access the result of horizontal consolidation among providers. Difference between means tests indicate that continuity of care is disrupted when comparing pre- and post-merger data when studying the effects of horizontal mergers; however, no effect was detected for vertical types of consolidation. Qualitative data indicate that satisfaction with plan and provider performance decreases after horizontal merger but increases with vertical merger.Conclusions: Overall, Medicaid managed care beneficiaries enjoy less access, continuity, and satisfaction with both health plans and providers after a horizontal merger. However, when integration occurs vertically, post- merger beneficiaries are more likely to report higher satisfaction with both plans and providers. Access to care also improves under vertical arrangements, but continuity of care remains unchanged from pre-merger status. Implications for Policy, Delivery, or Practice: Antitrust agents in health care should take into account not only potential market efficiencies when considering consolidation among health plans but also potential effects on plan beneficiaries. While cost remains a salient issue, evidence from this study indicates that vertical strategies may better serve high-risk populations by providing a greater number of services and improving satisfaction and access. Primary Funding Source: Departmental Research Funds.
Publication Types:
Keywords:
- Delivery of Health Care
- Health Care Sector
- Health Maintenance Organizations
- Humans
- Insurance, Health
- Managed Care Programs
- Medicaid
- economics
- hsrmtgs
Other ID:
UI: 102272260
From Meeting Abstracts