Context Health plans competing in a managed care system may face serious financial consequences if they are disproportionately selected by enrollees with expensive health conditions.
Academic medical centers (AMCs) have traditionally provided medical care for the sickest patients and may be at particularly high risk for adverse selection, but whether this occurs is not known.
Objective To determine whether managed care organizations (MCOs) representing AMCs are adversely selected by Medicaid managed care (MMC) enrollees with expensive chronic health conditions.
Design and Setting Observational study using state Medicaid claims data from all of 1994 and January to August 1995 for Tennessee's statewide MMC program (TennCare).
Participants All 12 capitated MCOs in Tennessee, which collectively provided services for 1.2 million Medicaid enrollees from January 1994 through August 1995 following the initiation of TennCare.
Main Outcome Measures Prevalence of 6 state-specified high-cost chronic conditions-acquired immunodeficiency syndrome (AIDS), coagulation defects, cystic fibrosis, pregnancy, prematurity, and organ transplantation-and 27 additional high-cost conditions compared by academic, statewide, and regional MCOs.
Results The prevalence of state-specified high-cost chronic conditions was generally higher for academic MCOs compared with other MCOs.
Specifically, prevalence of AIDS was 14.1 times higher in academic MCOs than in statewide MCOs ; coagulation defects, 6. (...)
Mots-clés Pascal : Soin intégré, Disparité, Economie santé, Homme, Tennessee, Etats Unis, Amérique du Nord, Amérique, Medicaid, Case mix
Mots-clés Pascal anglais : Managed care, Disparity, Health economy, Human, Tennessee, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0461199
Code Inist : 002B30A01B. Création : 22/03/2000.