1 / 19

Managed Care

Causal Effect of Managed Care on Health Care Quality: Evidence from Cancer Screening Guideline Discontinuities Srikanth Kadiyala* Grant Miller** Harvard University Funding: *Sloan Foundation, **NIH.

starr
Download Presentation

Managed Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Causal Effect of Managed Care on Health Care Quality: Evidence from Cancer Screening Guideline DiscontinuitiesSrikanth Kadiyala*Grant Miller**Harvard UniversityFunding: *Sloan Foundation, **NIH

  2. Dr. Sandy MacColl [one of the founders of GHC] wrote that he and his colleagues sought a “system of family care…directed towards a goal of good care, health maintenance and preventive services” Crowley,To serve the greatest number: A History of the GHC of Puget Sound

  3. Managed Care • Held Great Promise for Quality Improvements • Lower Cost • Appropriate Use of Medical Care • Conventional View is that it has Failed • We Contend Jury is Still Out

  4. Previous Research • Randomized Control Trial • Rand HI experiment (late 1970s) • Cross-Sectional Studies • Selection problem since assignment to insurance type is NOT random • Control for observables • Findings Equivocal

  5. New Empirical Strategy Discontinuity design using age-specific preventive service guidelines • Within plan comparisons of preventive service use across guideline thresholds difference out selection effects • Guidelines are “bright lines”-No discrete increase in cancer risk at these ages

  6. Cancer Screenings Recommendations • U.S Preventive Task Force (USPSTF) and American Cancer Society (ACS) • Colorectal Cancer • USPSTF & ACS – Both recommend screening for individuals age 40+ • No recommendation on screening technology • Breast Cancer • ACS-Recommended mammography for women ages 40+ since early 1980s • USPSTF-Recently switched to 40+, previously 50+ • Thus we look for changes over both the 40 and 50 year thresholds • Prostate Cancer • USPSTF-Does not recommend PSA • ACS-Physicians should offer PSA • Screening is Recommended for these diseases ONLY for asymptomatic people above a certain age • IOM/ Quality Chasm report: Cancer Screenings UNDERUSED

  7. Natural Experiment Framework Managed Care FFS Pre- guideline Post Guideline Pre- guideline Post Guideline 49 49 50 50 Difference-In-Difference-In-Difference = [ (D-B)-(C-A) ] – [(H-F)-(G-E)]

  8. Regression Discontinuity FFS Managed Care Post Guideline Post Guideline 49 49 50 50 • Diff.-In-Diff.=[(D-B)] – [(H-F)] • -This assumes that [(G-E)-(C-A)] is zero, which is a • plausible assumption

  9. Data • National Health Interview Survey(NHIS): • National Sample of Individuals • Breast Cancer (N=6807,Years 1998-2000) • Colorectal Cancer (N=3426,Year 2000) • Prostate Cancer(N=1543,Year 2000) • Insurance Plan Types • Group/Staff Models, IPA, POS, PPO, Fee-For-Service(FFS) • Rich Set of Covariates • Income, Education, Race, Region, Marital Status • Also MarketScan Data 1997-2001(these results not reported)

  10. Colorectal Cancer: Any Screening in Last Year by Plan and Age NHIS Data-Year 2000

  11. Breast Cancer: Mammogram Use in Last Year by Plan and Age NHIS Data: 1998-2000

  12. Breast Cancer: Mammogram Use in Last Year by Plan and Age NHIS Data: 1998-2000

  13. Prostate CancerPSA Test Use in Last Yearby Plan and Age NHIS DATA: Year 2000

  14. Regression Discontinuity Estimate using Colorectal Cancer: Means by Plan and Age Group

  15. Regression Estimates of Screening Use Standard Errors in parantheses. Bold indicates point estimate is significant at the 5% level. Italics means significant at the 10% level. Regression models adjust for age,sex,race, education, income,marital status, region and time where appropriate.

  16. Results from Cross-Section Regressions Standard Errors in parantheses. Bold indicates point estimate is significant at the 5% level. Regression models adjust for age,sex,race, education, income,marital status, region and time where appropriate.

  17. Interpretation of Results • Change in Use across Age thresholds generally larger in Managed Care Plans • Large statistically significant differences for Colorectal and Breast Cancer screenings • No Statistically Significant differences for Prostate Cancer Screening • Strongest Results for the Group/Staff Managed Care Models

  18. Supply or Demand • Survey data indicates individuals don’t know the right age cutoffs • We know whether people were offered screening services in the 2000 NHIS data • Using the same framework as above we find large statistically significant changes in Offer rates across the relevant age thresholds • This indicates that supply side responses drive changes in use over the age thresholds.

  19. Future Work • How does Managed Care do it? • Plan Characteristics • Health Effects • Other treatments with Age Thresholds • Ex. Cholesterol Screening

More Related