Medicaid Payment system: Impact on Health Care Utilization and Medication Adherence in Asthmatic children Medicaid enrollees

Objectives: Very few studies have captured the differences in the outcomes of Medicaid patients on the basis of fee-for-service and capitation based health plan. This study measures the impact of fee-for-service vs. capitation on healthcare utilization and medication adherence in children diagnosed with asthma enrolled in Medicaid. Methods: This was a retrospective cohort study analyzing Medicaid data from 8 states licensed under Thomson Medstat. The data comprised of medical records (healthcare service utilizations), drug intake information and eligibility records of 6435 Medicaid enrolled children with diagnosis of asthma that had newly started pharmacotherapy for asthma. The patients were followed 12 months pre and post index period characterized by use of anti-asthmatic medication to study the impact on health care utilization and medication adherence. Multiple logistic regression analysis was used to study medication adherence and Poisson regression was used to determine healthcare utilization. Results: Medication adherence was 39% (p<0.05) lower for patients on a capitation plan. Also, compared to patients in a FFS plan, patients in a capitation plan had 77% (p<0.05) more inpatient hospitalizations, 42% fewer outpatient visits and 34% (p<0.05) increased odds of emergency department visits. Conclusion: Medicaid programs primarily use capitation based managed care plans for keeping a check on the healthcare costs. However, these plans might not be that cost-effective for the long-term management of asthma. The policy makers and third party payers should consider disease specific needs of children in order to achieve improved access to care and medications for better management of that particular disease.