Objective: To quantitatively evaluate the impact of a Medicaid managed care program on total physician utilization in the State of Georgia.
Background: Georgia Better Health Care (GBHC) is Georgia's Medicaid managed care program. First implemented in seven counties in 1993, the program was gradually expanded and became statewide in 1998. Previous research in other states suggested that total physician visits would increase. This increase would stem from improved access to physician services resulting from each recipient having an assigned primary care physician.
Methods: Utilization of physician services can be analyzed as a two-stage decision process. The first stage (contact) is the recipient's decision to seek a physician's services. The second stage (frequency) is controlled largely by the physician's decision on the amount of services to provide.
Fifteen quarters of recipient-level data were analyzed. Models for total physician visits, contact and frequency decisions were constructed using Poisson and negative binomial regression as appropriate for the data. The models controlled for gender, age and geographic area.
Results: Membership in GBHC was associated with a reduction in overall total physician utilization, as well as in both the contact and frequency stages. Total physician utilization was reduced by a mean of 15.96% (median: 17.26, range: 33.76). Physician contact was reduced by a mean of 3.26% (median: 3.09, range: 4.75). Frequency of physician visits – given at least one contact – were reduced by a mean of 15.30% (median: 14.59, range 40.82).
Conclusions: The introduction of a Medicaid managed care program in Georgia has significantly reduced physician utilization.
Learning Objectives: As the result of this session, participants should: 1) Understand the two-stage model of physician utilization 2) Understand the use of count regression models in the analysis of physician utilization 3) Evaluate the impact of Georgia's Medicaid managed care program
Keywords: Health Care Managed Care, Evaluation
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.