Evidence for selective health maintenance organization enrollment among children and adolescents covered by Medicaid
D. W. West, M. E. Stuart, A. K. Duggan and C. D. DeAngelis
Division of General Pediatrics, Alfred I. DuPont Institute, Wilmington, DE, USA.
OBJECTIVE: To determine whether children and adolescents are selectively
enrolled in health maintenance organizations (HMOs) based on age, gender,
diagnosis, or prior utilization. DESIGN: Case-control study. New HMO
enrollees were compared with a control population of non-HMO enrollees.
SETTING: Medicaid claims data and HMO participation records for the
Medicaid and Aid to Families of Dependent Children sector in Baltimore, Md.
RESULTS: Controlling for age, significant differences in prior health care
utilization as measured by Medicaid expenditures and hospital days were
noted. Children enrolling in HMOs had significantly lower prior utilization
than children from the control population as measured by dollar
expenditures and hospital days. Young children enrolling in HMOs were only
half as likely to have prior claims for asthma. Conversely, adolescents
enrolling in HMOs had significantly higher prior utilization than
adolescents from the control population. The difference among adolescents
was due to a higher birth rate among new HMO enrollees in that age bracket.
CONCLUSIONS: Voluntary HMO enrollment of children covered by Medicaid and
Aid to Families of Dependent Children sector was subject to selection
biases that may be economically favorable to the HMOs and may undermine the
cost-containment goals of prepaid health care for Medicaid participants.
Voluntary capitated systems where fee-for-service remains a significant
alternative must monitor for these selection biases that are not allowed
for in the adjustments to capitation rates.
Persistence of High Health Care Expenditures among Children in Medicaid
Shenkman et al.
Med Care Res Rev 2007;64:304-330.
ABSTRACT
Potential self-selection bias in a nested case-control study on indoor environmental factors and their association with asthma and allergic symptoms among pre-school children
Bornehag et al.
Scand J Public Health 2006;34:534-543.
ABSTRACT
Health Expenditures for Privately Insured Adults Enrolled in Managed Care Gatekeeping vs Indemnity Plans
Pati et al.
Am. J. Public Health 2005;95:286-291.
ABSTRACT
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Unmet Need for Routine and Specialty Care: Data From the National Survey of Children With Special Health Care Needs
Mayer et al.
Pediatrics 2004;113:e109-115.
ABSTRACT
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Risk Adjustment for Pediatric Quality Indicators
Kuhlthau et al.
Pediatrics 2004;113:210-216.
ABSTRACT
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The Evolution of the State Children's Health Insurance Program (SCHIP) in New York: Changing Program Features and Enrollee Characteristics
Dick et al.
Pediatrics 2003;112:e542-550.
ABSTRACT
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Switching to Gatekeeping: Changes in Expenditures and Utilization for Children
Ferris et al.
Pediatrics 2001;108:283-290.
ABSTRACT
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Effects of Medicaid Managed Care on Health Care Use: Infant Emergency Department and Ambulatory Services
Alessandrini et al.
Pediatrics 2001;108:103-110.
ABSTRACT
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Selection Bias in HMOs: A Review of the Evidence
Hellinger and Wong
Med Care Res Rev 2000;57:405-439.
ABSTRACT
Changes in the Daily Practice of Primary Care for Children
Ferris et al.
Arch Pediatr Adolesc Med 1998;152:227-233.
ABSTRACT
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