Related Experiment Video
Updated: Apr 12, 2026
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Medicare Managed Care Spillovers and Treatment Intensity
1Grand Valley State University, Grand Rapids, MI, USA.
Abstract:
Evidence suggests that the share of Medicare managed care enrollees in a region affects the costs of treating traditional fee-for-service (FFS) Medicare beneficiaries; however, little is known about the mechanisms through which these 'spillover effects' operate. This paper examines the relationship between Medicare managed care penetration and treatment intensity for FFS enrollees hospitalized with a primary diagnosis of AMI. I find that increased Medicare managed care penetration is associated with a reduction in both the costs and the treatment intensity of FFS AMI patients. Specifically, as Medicare managed care penetration increases, FFS AMI patients are less likely to receive surgical reperfusion and mechanical ventilation and to experience an overall reduction in the number of inpatient procedures. Copyright © 2015 John Wiley & Sons, Ltd.
Insights
Higher Medicare managed care enrollment reduces treatment intensity and costs for traditional fee-for-service (FFS) beneficiaries hospitalized with acute myocardial infarction (AMI). This suggests managed care influences care patterns for non-managed care patients.
Area of Science:
- Health Economics
- Healthcare Management
- Clinical Outcomes Research
Background:
- Medicare managed care's influence on traditional fee-for-service (FFS) costs is recognized.
- Mechanisms behind these 'spillover effects' remain unclear.
Purpose of the Study:
- To investigate the relationship between Medicare managed care penetration and treatment intensity for FFS patients with acute myocardial infarction (AMI).
Main Methods:
- Analysis of Medicare managed care penetration rates.
- Examination of treatment intensity metrics for FFS AMI patients.
- Statistical assessment of correlations between penetration and care received.
Main Results:
- Increased Medicare managed care penetration correlates with reduced treatment intensity for FFS AMI patients.
- Higher penetration is linked to decreased likelihood of surgical reperfusion and mechanical ventilation.
- A reduction in overall inpatient procedures for FFS AMI patients was observed with increased managed care penetration.
Conclusions:
- Medicare managed care penetration impacts treatment intensity and costs for FFS AMI patients.
- Managed care may drive more conservative treatment approaches, even for non-enrollees.
- Further research into care coordination and provider behavior is warranted.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:24Drug Accumulation During Multiple Dosing: Intermittent IV Infusions
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:15Nursing Implementation
The five steps to implementing effective nursing care include reassessing the patient, reviewing and revising the existing nursing care plan, organizing the resources and care delivery, anticipating and preventing complications, and implementing nursing interventions.
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...