| Titre : | Unhealthy Competition : Consequences of Health Plan Choice in California Medicaid. (2010) |
| Auteurs : | MILLETT (Christopher) : USA. Christopher Millett was with the Division of General Internal Medicine. San Francisco General Hospital. San Francisco. CA. ; Andrew-B BINDMAN ; Arpita CHATTOPADHYAY ; Division of General Internal Medicine. San Francisco General Hospital. And the Department of Medicine. University of California. San Francisco. CA. USA |
| Type de document : | Article |
| Dans : | American journal of public health (vol. 100, n° 11, 2010) |
| Pagination : | 2235-2240 |
| Langues: | Anglais |
| Mots-clés : | Assurance maladie ; Protection sociale ; Amérique ; Medicaid ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST-CNRS sp9R0xHH. Diffusion soumise à autorisation]. Objectives. We compared the quality of care received by managed care Medicaid beneficiaries in counties with a choice of health plans and counties with no choice. Methods. This cross-sectional study among California Medicaid beneficiaries was conducted during 2002. We used a multivariate Poisson model to calculate adjusted rates of hospital admissions for ambulatory care-sensitive conditions by duration of plan enrollment. Results. Among beneficiaries with continuous Medicaid coverage, the percentage with 12 months of continuous enrollment in a health plan was significantly lower in counties with a choice of plans than in counties with no choice (79.2% vs 95.2% ; P<. 001). Annual ambulatory care-sensitive admission rates adjusted for age, gender, and race/ethnicity were significantly higher among beneficiaries living in counties with a choice of plans (6.58 admissions per 1000 beneficiaries ; 95% confidence interval [CI]=6.57,6.58) than among those in counties with no choice (6.27 per 1000 ; 95% CI=6.27,6.28). Conclusions. Potential benefits of health plan choice may be undermined by transaction costs of delayed enrollment, which may increase the probability of hospitalization for ambulatory care-sensitive conditions. |
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