Findings Brief

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Research and policy experts often assume that growth in the market penetration of managed care organizations (MCOs) and the incentives they use to control costs have changed health care market behavior across the board. However, according to new research by Paul L. Hebert, Ph.D., and his colleagues at the Mount Sinai School of Medicine, there is little evidence to suggest a spillover effect of managed care market penetration on individuals with diabetes in the non-managed care sector, specifically Medicare beneficiaries with diabetes enrolled in fee-for-service (FFS) plans.

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With the growth of consumer-directed health plans, pay for performance programs, and provider tiering, it is important that the tools used to rank physicians provide consumers and payers with an accurate representation of physician treatment behavior. In particular, accurate measures of physician cost efficiency allow consumers to make more informed decisions while helping health plans make better choices about which physicians to include in their networks. However, a recent HCFO-funded study by J. William Thomas, PhD, of the University of Southern Maine and Kyle L.

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A study led by Gloria Bazzoli, Ph.D., at the Institute for Health Services Research and Policy at Northwestern University, along with coprincipal investigators Lawton Burns, Ph.D., also at Northwestern, and Robert Miller, Ph.D., at the University of California – San Francisco, examined the relationships between physician-hospital arrangements and managed care organizations to determine their effects on organizational integration and on costs for hospital based care.

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Different types of Medicaid managed care (MMC) programs—mandatory HMOs, primary care case management (PCCM) programs, and combination HMO/PCCM programs—affect beneficiaries’ access to and use of health care services in different ways, according to research at the Urban Institute by Stephen Zuckerman, Ph.D., Niall Brennan, and Alshadye Yemane. “The study shows that state decisions about which type of Medicaid managed care program to implement and who to include in mandatory enrollment will significantly influence a program’s effect,” says Zuckerman.

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Research funded by the Changes in Health Care Financing and Organization program has resulted in important findings on the effects of reforms to the Medigap program. Although Medigap coverage receives little public attention, it is a critical source of health insurance for about one-quarter of Medicare beneficiaries, for whom Medigap reimburses for cost sharing and selected services that Medicare does not cover. It is particularly important for researchers and policymakers to understand the role of Medigap coverage as Congress considers reforming the Medicare program.

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Infant mortality rates in the United States remain higher than in most industrialized countries, particularly for minorities and women who do notreceive adequate prenatal care.1 Since many low-income pregnant women receive cash assistance (welfare) or are eligible for Medicaid, changes in these public programs affect them directly.

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Despite fears to the contrary, Medicare’s prospective payment system (PPS) for skilled nursing facilities (SNF) has not had a significant adverse effect on nursing-home residents in Ohio, according to findings from a study by David Gifford, M.D., and Joseph Angelelli, Ph.D., at Brown University’s Center for

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With the SCHIP program enrolling 897,000 children in its first year of operation, questions remained: Did SCHIP reach its target population? What proportion of new enrollees were the previously uninsured versus those who substituted prior private coverage or Medicaid benefits? While previous literature suggests that Medicaid expansions have led to reductions in both uninsurance and private coverage (based on varying state requirements and household income levels), no studies had used longitudinal data to assess this SCHIP infancy period.

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People enrolled in health maintenance organizations (HMOs) experience fewer disparities than patients insured through traditional indemnity plans, at least for education factors, according to new findings at the University of Rochester. Kevin Fiscella, M.D., and colleagues found that health care utilization rates were roughly similar among HMO enrollees, regardless of their level of education. HMO membership had no appreciable effects on income or racial/ethnic-related disparities in health utilization; disparities for these groups were comparable to non-HMO insurance.