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Do For-profit health plans restrict access to high-cost procedures? - 24/08/11

Doi : 10.1016/j.ehbc.2004.03.021 
Antonio J Trujillo, PhD : Commentary Author
Health Services Administration Program, Department of Health Professions, College of Health and Public Affairs, University of Central Florida, Orlando, Florida USA 

Abstract

Question

Do for-profit health plans restrict access to high-cost procedures compared with not-for-profit health plans?

Study design

Cohort study.

Main results

In unadjusted analyses, for-profit health plan beneficiaries had higher rates of all high-cost procedures than not-for-profit health plan beneficiaries; the difference was significant for 4 out of 12 procedures (see Table 1). Rates of usage remained higher in for-profit plans after adjustment for participants’ sociodemographic factors, county of residence, and health plan characteristics (see Table 1).

Table 1 Difference in rates of high-cost procedures between for-profit plans and not-for-profit plans. 
Procedure Difference per 10,000 beneficiaries (95% CI) 
 Unadjusted Adjusted for sociodemographic factors Adjusted for health plan characteristics, sociodemographic Adjusted for county of residence, sociodemographic factors, health plan characteristics 
Hysterectomy 2.6 (−0.3 to 5.5) 2.7 (−0.2 to 5.6) 2.2 (−1.0 to 5.4) 2.5 (0.6 to 4.3)§ 
Prostatectomy 4.3 (−1.4 to 10.1) 3.8 (−1.9 to 9.6) 3.3 (−3.1 to 9.8) 6.3 (0.2 to 12.3)§ 
Closed cholecystectomy 5.8 (−0.2 to 11.9) 6.1 (0.1 to 12.1)§ 7.0 (0.4 to 13.6)§ 7.7 (3.4 to 11.9)§ 
Open cholecystectomy 0.8 (−1.6 to 3.1) 0.8 (−1.5 to 3.2) 0.6 (−2.1 to 3.3) 1.9 (−0.1 to 3.8) 
Partial colectomy 4.0 (−1.0 to 9.0) 4.4 (−0.6 to 9.4) 6.0 (0.3 to 11.6)§ 8.4 (4.8 to 12.0)§ 
Reduction of femur fracture 2.6 (−2.9 to 8.2) 6.0 (0.5 to 11.4)§ 5.3 (−0.9 to 11.4) 6.4 (1.1 to 11.6)§ 
Total knee replacement 5.1 (−1.0 to 11.2) 5.1 (−0.9 to 11.2) 5.7 (−0.9 to 12.4) 8.3 (3.1 to 13.6)§ 
Total hip replacement 2.4 (−5.1 to 10.0) 3.0 (−4.5 to 10.5) 2.3 (−6.2 to 10.9) 5.4 (0.8 to 9.9)§ 
Cardiac catheterisation 31.6 (9.0 to 54.2)§ 31.0 (8.7 to 53.3)§ 15.2 (−9.2 to 39.5) 26.5 (14.1 to 38.9)§ 
Coronary artery bypass grafting 10.3 (2.5 to 15.1)§ 10.7 (3.1 to 18.3)§ 7.6 (−1.0 to 16.2) 6.3 (0 to 12.7)§ 
Percutaneous transluminal coronary angioplasty 8.5 (1.0 to 16.1)§ 9.0 (1.6 to 16.4)§ 6.0 (−2.3 to 14.3) 2.6 (−2.8 to 8.0) 
Carotid endarterectomy 5.4 (1.0 to 9.9)§ 6.0 (1.6 to 10.4)§ 2.3 (−2.5 to 7.1) 4.2 (1.1 to 7.3)§ 
Sociodemographic factors: sex, age, race or ethnic group, income, education, rural or urban residence, Medicaid eligibility. Health plan characteristics: years in operation, number of beneficiaries, health plan model type (independent practice association, network, mixed, group or staff). Differences weighted according to county of residence of beneficiaries. §P<0.05. 

Authors’ conclusions

There is no evidence that for-profit heath plan beneficiaries are less likely to receive high-cost procedures than not-for-profit health plan beneficiaries.

Le texte complet de cet article est disponible en PDF.

Keywords : Health care surveys, Health insurance, Medicare, Health economics, Cohort study


Plan


 Abstracted from: Schneider EC, Zaslavsky AM, Epstein AM. Use of high-cost operative procedures by medicare beneficiaries enrolled in for-profit and not-for-profit health plans. N Engl J Med 2004; 350: 143–150.


© 2004  Elsevier Ltd. Tous droits réservés.
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Vol 8 - N° 3

P. 116-118 - juin 2004 Retour au numéro
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