Differences in the volume of services and in prices drive big variations in medicaid spending among US states and regions

Health Affairs

Volumn 30, Issue 7, 2011, Pages 1316-1324

  Gilmer, Todd P ^a   Kronick, Richard G ^b  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b U S DEPARTMENT OF HEALTH AND HUMAN SERVICES   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACT; ARTICLE; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE QUALITY; HEALTH SERVICE; HUMAN; MEDICAID; UNITED STATES;

AMBULATORY CARE; DATABASES, FACTUAL; DRUG UTILIZATION; HEALTH CARE SURVEYS; HEALTH EXPENDITURES; HOSPITALIZATION; HUMANS; MEDICAID; MID-ATLANTIC REGION; PATIENT PROTECTION AND AFFORDABLE CARE ACT; UNITED STATES; WORKLOAD;

EID: 79960258724     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.0106     Document Type: Article

References (15)

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2. Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science. 1973;(182):1102-8.
3. Fisher ES, Wennberg DE, Stukel TA, Gottliewb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273-87.
4. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4): 288-98.
5. Gilmer T, Kronick R, Rice T. Children welcome, adults need not apply: changes in public program enrollment across states and over time. Med Care Res Rev. 2005;62(1): 56-68.
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7. Centers for Medicare and Medicaid Services. Medicaid Analytic eXtract (MAX) general information [Internet]. Baltimore (MD): CMS; [cited 2011 May 13]. Available from: http://www.cms.hhs.gov/medicaiddatasourcesgeninfo/07_maxgeneralinformation.asp
8. To access the Appendix, click on the Appendix link in the box to the right of the article online
9. We investigated whether variation across states in disability determination rates or eligibility criteria (eleven states are section 209[b] states and use more restrictive Medicaid eligibility criteria for their aged, blind, and disabled recipients) might be related to Medicaid spending. We found no significant correlations between costs or use of health services with the disability determination rate, as measured by the participation rate of cash assistance, Medicaid-only disabled beneficiaries as a percentage of the population in families with incomes under 200 percent of poverty, or with 209(b) status.
10. We excluded beneficiaries with any comprehensive managed care during a year (we included beneficiaries with primary care case management). We also excluded six states with a managed care penetration rate of 75 percent or higher (AZ, DE, MD, MI, NM, PA), under the assumption that the remainingbeneficiaries would not be representative of the general Medicaid population in that state. We excluded two states because of the poor quality of their hospital admission data (AL, ND).
11. University of California, San Diego. Chronic illness and disability payment system [Internet]. San Diego (CA): Trustees of the University of California; [cited 2011 May 13]. Available from: http://cdps.ucsd.edu
12. The price of an outpatient visit reflects both the unit rate of payment per service, as well as the number and type of services received during the day. It is not a pure measure of price, but rather a measure that includes some components of volume as well.
13. Census Bureau. Census regions and divisions of the United States [Internet]. Washington (DC); Census Bureau; [cited 2011 May 13]. Available from: http://www.census.gov/geo/www/us_regdiv.pdf
14. Backus L, Moron M, Bacchetti P, Baker L, Bindman AB. Effect of managed care on preventable hospitalization rates in California. Med Care. 2002;40(4):315-24.
15. Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth atlas of health care-atlas downloads crosswalk files [Internet]. Lebanon (NH): Trustees of Dartmouth College; [cited 2011 May 13]. Available from: http://www.dartmouthatlas.org/data/download.shtm