Difference in Hospital Utilization Within the First 12 Months Among Low-Birth-Weight Infants in Medicaid Managed Care Versus Fee-for-Service: A Regression Discontinuity Study
Related Experiment Video
Updated: Nov 1, 2025
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Sze Yan Liu1,2, Sungwoo Lim3
1Department of Public Health, Montclair State University, Montclair, NJ, USA. lius@montclair.edu.
Insights
Medicaid managed care (MMC) may slightly increase hospitalization for low-birth-weight (LBW) infants compared to Medicaid fee-for-service (FFS). Further research is needed for high-risk populations.
Area of Science:
- Health Services Research
- Pediatric Health Outcomes
- Public Health Policy
Background:
- Low-birth-weight (LBW) infants represent a vulnerable population with complex healthcare needs.
- Understanding the impact of different insurance models on healthcare utilization for LBW infants is crucial for optimizing care.
- Medicaid managed care (MMC) and Medicaid fee-for-service (FFS) are distinct healthcare delivery systems with potentially different effects on patient outcomes.
Purpose of the Study:
- To compare the effects of Medicaid managed care (MMC) versus Medicaid fee-for-service (FFS) on emergency department (ED) use and hospitalization rates.
- To analyze these effects specifically within the first 6 and 12 months of life for low-birth-weight (LBW) infants.
Main Methods:
- Utilized the New York City Office of Vital Statistics-Statewide Planning and Research Cooperative System (OVS-SPARCS) dataset.
- Identified 9135 LBW infants born to Medicaid beneficiaries in NYC (January 2008-March 2012).
- Employed a regression discontinuity framework based on a New York State Medicaid policy differentiating enrollment in MMC or FFS by infant birth weight (<1200g vs. 1200-2500g) within the first six months.
Main Results:
- LBW infants enrolled in MMC demonstrated a statistically significant, albeit small, increase in hospitalization probability within the first year of life compared to those in FFS.
- The average increase in hospitalization probability for LBW infants in MMC was 0.16 percentage points (p=0.04).
Conclusions:
- The study suggests potential differences in healthcare utilization patterns between MMC and FFS for LBW infants.
- Additional research is warranted to fully elucidate these differences, particularly for high-risk patient groups within these insurance models.
Objective:
To examine the effect of Medicaid managed care (MMC) versus Medicaid fee-for-service (FFS) on emergency department (ED) use and hospitalization during the first 6 and 12 months of life among low-birth-weight (LBW) infants.
Methods:
We used the New York City Office of Vital Statistics-Statewide Planning and Research Cooperative System (OVS-SPARCS) dataset to identify 9135 LBW infants born to female Medicaid beneficiaries in New York City from January 2008-March 2012. We applied a robust regression discontinuity framework using a New York State Medicaid policy in effect at that time. This policy automatically enrolled infants born to female Medicaid beneficiaries to Medicaid managed care (MMC) or Medicaid fee-for-service (FFS) based on their birth weight (less than 1200 g vs. 1200-2500 g) during the first 6 months of their lives.
Results:
LBW infants in MMC had an average 0.16% points higher probability of being hospitalized within the first year of their lives than those in Medicaid FFS (p-value = 0.04).
Conclusions For Practice:
More research is necessary to understand possible differences in healthcare utilization between MMC and FFS participants with high health risks.
Related Concept Videos
01:52Regression Toward the Mean
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...
01:26Methods 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...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include: