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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Tricia J. Johnson, MA, MS, Department of Economics, Arizona State University, Box 873806, Tempe, AZ 85287-3806, 480 965 8321, tricia.johnson@asu.edu
INTRODUCTION: Managed care has been seen as a way for health insurers to control escalating costs by eliminating unnecessary care. Critics maintain, however, that their control has gone too far in monitoring utilization. Policy makers and other organizations have proposed a variety of mechanisms to counter the control of managed care organizations. These changes effectively give autonomy back to the provider by relaxing managed care organizations’ utilization controls and oversight. Providers may respond to the liberalized regulations by increasing the quantity of services provided, switching to a more intensive mix of services, using a combination of quantity and service mix changes, or by maintaining their current utilization practices. While research exists on the effects of tightening control on health care providers through fee reductions and utilization constraints, empirical research has not examined the effects of liberalizing these constraints.
The state of California implemented changes to its workers’ compensation system in 1994, which broadened the authority of providers in the treatment of occupational injuries. A subsequent legal interpretation of the statutes resulted in a further relaxation of these constraints. This study examines the effects of relaxing utilization management constraints on the quantity and mix of services provided. This policy change provides a microcosm to examine the broader effects of relaxing managed care constraints.
METHODS: Data consist of over 500,000 workers’ compensation claims with injuries occurring between 1993 and 1999 from the state of California, providing information on claimant, injury and provider characteristics. Claims with physician-driven care versus chiropractic-driven care are examined separately. The most common types of occupational injuries are analyzed to isolate changes associated with injuries with well-defined standards of care versus more ambiguous standards of care.
RESULTS AND CONCLUSIONS: Multivariate logistic regression models incorporating health and non-health characteristics are used to estimate changes in service utilization according to patterns of care for each type of injury. Within each pattern of care, changes in the quantities of services are estimated using a generalized method of moments approach. The effects of relaxing utilization constraints on physician and chiropractor-driven care are also compared.
The study provides policy makers, health insurers and workers’ compensation insurers with information needed to assess the effects of relaxing utilization constraints on provider behavior in terms of the quantity and mix of services, which directly affect the costs of care. In addition, a framework for estimating broader effects of relaxing managed care constraints is developed.
Learning Objectives:
Presenting author's disclosure statement:
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.