Dissertation/Thesis Abstract

Medicaid Payment Systems: Impact on Quality of Care, Medication Adherence and Healthcare Service Utilizations in Type 2 Diabetes Medicaid Enrollees
by Pawaskar, Manjiri D., Ph.D., The Ohio State University, 2008, 152; 10631344
Abstract (Summary)

The type of health plan/insurance coverage could have a significant impact on the quality of care and healthcare service utilizations of Medicaid beneficiaries. Poor medication adherence is associated with worse glycemic control, development of complications and overall increased healthcare utilizations in type 2 diabetic patients. The objective of this study was to examine the impact of the type of health plan (Capitated vs. Fee-For-Service (FFS)) on the quality of care, medication adherence and healthcare service utilizations in type 2 diabetes Medicaid enrollees.

This was a retrospective cohort study comprised of Medicaid enrollees with type 2 diabetes (n=8,581) who newly started oral pharmacotherapy. This study evaluated the Medstat MarketScan® MultiState Medicaid database from July 1, 2002 to December 31, 2005. Patients baseline characteristics such as demographic, clinical, medication-related and healthcare utilizations were extracted from the database. Patients were followed for 6 months before and 12 months after the index anti-diabetic medication to collect data on quality of care, medication adherence and healthcare service utilizations. Multiple log-linear regression analysis was used to predict medication adherence in type 2 diabetes patients. Multiple logistic regression analyses were employed to measure the quality of care (HbA1c tests, LDL-C tests, eye examinations) received by these patients while negative binomial regressions were used to examine healthcare service utilizations.

Patients enrolled in capitated health plans had a higher likelihood of receiving better quality of care compared to those with FFS plans. However, medication adherence was significantly lower in patients with capitated plans. Patients with capitation were associated with considerably higher number of hospitalizations and emergency room (ER) visits but lower number of outpatient visits compared to those with FFS plans.

Although capitated managed care plans are primarily used as a cost containment strategy in Medicaid programs, they may not be cost effective for the long term management of chronic conditions such as diabetes. It is essential to develop interventions involving a multidisciplinary team such as policy makers, payors, healthcare professionals and patients to improve medication adherence for optimal use of health care resources in type 2 diabetes Medicaid enrollees.

Indexing (document details)
Advisor: Balkrishnan, Rajesh
Commitee: Burch, Steven, Nahata, Milap, Seiber, Eric
School: The Ohio State University
Department: Pharmacy
School Location: United States -- Ohio
Source: DAI-B 78/11(E), Dissertation Abstracts International
Subjects: Pharmacy sciences
Keywords: Adherence, Capitation, Diabetes, Medicaid, Payment systems, Pharmaceuticals
Publication Number: 10631344
ISBN: 978-0-355-01598-0
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