Evaluation of the Medicaid competition demonstrations.
PubMedPublished 1 January 1989Open access
Deborah A. Freund, Louis F. Rossiter, Peter D. Fox, Jack A. Meyer, Robert E. Hurley, Timothy S. Carey
Citations76
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TL;DR
An overview and summary of evaluation findings on the effects of the demonstrations of Medicaid demonstrations in six States are presented.
Abstract
In 1983, the Health Care Financing Administration funded a multiyear evaluation of Medicaid demonstrations in six States. The alternative delivery systems represented by the demonstrations contained a number of innovative features, most notably capitation, case management, limitations on provider choice, and provider competition. Implementation and operation issues as well as demonstration effects on utilization and cost of care, administrative costs, rate setting, biased selection, quality of care, and access and satisfaction were evaluated. Both primary and secondary data sources were used in the evaluation. This article contains an overview and summary of evaluation findings on the effects of the demonstrations.
Keywords
Economics, Econometrics and FinanceHealth Professions
American Journal of Public HealthEmergency room use and primary care case management: evidence from four Medicaid demonstration programs.
142 Citations1989R Hurley, Deborah A. Freund +1 more
The findings suggest that gatekeeping designs can alter patterns of enrollee use with respect to the emergency room and some discussion of these implications is presented.
Health Care Management ReviewGatekeeping the emergency department: Impact of a Medicaid primary care case management program
48 Citations1989Robert E. Hurley, Deborah A. Freund +1 more
The impact of a primary care case management program on reducing the use of the emergency department (ED) as a source of nonemergency care is presented.
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38 Citations1988Robert E. Hurley, Deborah A. Freund
A typology for use in classifying and interpreting the findings of the growing empirical literature on managed care initiatives in the Medicaid program is presented.
Annual Review of Public HealthManaged Care in Medicaid: Selected Issues in Program Origins, Design, and Research
35 Citations1987Deborah A. Freund, R Hurley
A set of the initiatives used currently in the Medicaid program are described and how these new approaches are being evaluated are discussed to assess whether they attain their specific goals.
Health AffairsLessons Learned From Medicaid Managed Care Approaches
30 Citations1987Maren D. Anderson, Peter D. Fox
PubMedOverview of Medicaid capitation and case-management initiatives.
24 Citations1986Deborah A. Freund, Edward Neuschler
Case-management programs have grown in number and in acceptance in the Medicaid program since 1981 and their structure and incentives as well as what is known about their impact on cost and use are reviewed.
PubMedStatus of the Medicaid competition demonstrations.
17 Citations1986Robert E. Hurley
An overview of how the demonstration sites have approached the task of designing, developing, and implementing their various programs for Medicaid recipients is provided.
QRB - Quality Review BulletinGoing Into Gatekeeping: An Empirical Assessment
16 Citations1989Robert E. Hurley, John E. Paul +1 more
The results suggest that this relationship contributed to changes in health care utilization, including reductions in use of emergency rooms, specialists, and nonphysician providers and some increase in the likelihood of obtaining care from a primary care physician.
Medical CareThe Effect of Managed Care on Health Services Use by Dually Eligible Elders
16 Citations1989Thomas T. H. Wan
In modeling the determinants of health services use, it was found that the relationship between ambulatory physician visits and hospitalization of the elderly was complementary rather than substitutive.
Health PolicyCompetitive health plans and alternative payment arrangements for physicians in the United States: public sector examples
10 Citations1987Deborah A. Freund
Early evidence indicates that competing plans which place physicians at some financial risk and also employ administrative mechanisms are more likely to show cost savings than health plans that do not employ these methods.
Journal of Ambulatory Care ManagementThe private delivery of Medicaid services
9 Citations1986Deborah A. Freund
PubMedFindings from the Medicaid Competition Demonstrations: a guide for states.
8 Citations1990LuAnn Heinen, Peter D. Fox +1 more
Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance.
PubMedDeterminants of provider selection or assignment in a mandatory case management program and their implications for utilization.
7 Citations1988R Hurley, Deborah A. Freund
Characteristics and use experiences of assignees compared with selectors found that the assignees enjoyed better health than the selectors and were less likely to have had a regular source of care prior to the program.