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

Cohort study.

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.

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.