Do For-Profit Health Plans Restrict Access to Care Under Medicaid Managed Care?

Abstract

Managed care is now the norm for many on Medicaid, with approximately 19 million people on Medicaid enrolled in health maintenance organizations. In 2005, nearly 300 plans nationwide participated in state Medicaid managed care programs, with many of those plans operating under for-profit ownership. Concerns about the impact of plan ownership on access to care arise because of differences in the incentives in place in forprofit and nonprofit organizations that may lead for-profit plans to restrict access to care. Using data from the 2002 National Survey of America's Families on plan enrollment for a national sample of Medicaid enrollees, this study examines the link between for-profit plan ownership and enrollees' access to health care. The results suggest that access to care for Medicaid enrollees may be better under nonprofit plans than for-profit plans.

Factors Associated With Emergency Department Use Among the Rural Elderly

“…Second, Medicaid managed care may limit enrollees’ health services use. Access to care has been shown to be worse under for‐profit than not‐for‐profit plans for Medicaid managed care enrollees 59 . Third, Medicaid managed care may be superior to other health services (eg, they may focus on providing continuity of primary care services to enrollees), thereby keeping people healthier and reducing the likelihood of ED use 60 …”

Food away from home expenditures and obesity among older Europeans: are there gender differences?

“…In the next sections, we thoroughly scrutinize this external set of instruments for exogeneity, relevance, and validity and find that this specific set of external instruments is weak. An alternative to external instruments is Lewbel's (2010) method which exploits heteroskedasticity in the first stage regression to achieve identification (instead of identification through standard exclusion restrictions). Instruments are then constructed from variables within the given set of covariates (X and Z vector in our case).…”

“…This method is not of course without caveats. As Lewbel (2010) notes, "the resulting identification is based on higher moments, and so is likely to provide less reliable estimates than identification based on standard exclusion restrictions." However it "...may be useful in applications where traditional instruments are not available, or could be used along with traditional instruments to increase efficiency."…”

“…To cope with weak instruments, we complement our estimations with the Limited Information Maximum Likelihood (LIML) and the Fuller's modified LIML (FULL) estimators. 13 In addition, as an alternative to the external instrument list for achieving identification, we exploit the heteroskedasticity in the first stage regressions 14 and follow Lewbel's (2010) method in developing additional instruments for the estimation. Specifically, we construct instruments in the form of (w −w)ê i , where w is any continuous variable of the X or Z vector in Eq.…”

Does it Matter if Your Health Insurer is For-Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending

“…Using data on Medicare HMOs from 1998, Schneider et al (2003) Studies comparing FP and NFP healthplans also find that consumer satisfaction is higher among enrollees of NFP plans (Gillies et al 2006), especially for patients in poor health (Tu and Reschovsky 2002). Finally, NFP plans appear to perform better with respect to provision of care for less affluent populations such as Medicaid enrollees (Long 2008).…”