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Ambulatory care practice variation within a Medicaid program

J P Weiner1, B H Starfield, N R Powe

  • 1Johns Hopkins University, School of Public Health, Department of Health Policy and Management, Baltimore, MD 21205, USA.

Health Services Research
|February 1, 1996
PubMed
Summary
This summary is machine-generated.

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Healthcare resource use varies significantly among Medicaid providers and regions, even after accounting for patient case mix. Patient factors explain most variation, highlighting the need for risk adjustment in analyzing healthcare efficiency.

Area of Science:

  • Health Services Research
  • Healthcare Policy
  • Medical Economics

Background:

  • Ambulatory care practice patterns and resource consumption can vary significantly.
  • Understanding this variation is crucial for optimizing healthcare delivery and costs within public programs like Medicaid.

Purpose of the Study:

  • To assess the extent of variation in ambulatory care practice patterns within a state's Medicaid program after controlling for patient case mix.
  • To determine how much of this variation in resource consumption is attributable to provider, patient, and geographic factors.

Main Methods:

  • Cross-sectional study of Maryland Medicaid enrollees (FY 1988) using claims data for 134,725 individuals.
  • Utilized the Ambulatory Care Group (ACG) measure for case mix adjustment.

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  • Assigned patients a usual source of care (primary provider) based on service patterns.

    • Main Results:

    • Significant variation in resource use by primary provider type after case mix control: 19% (visits) to 81% (hospitalizations).
    • Geographic variation was substantial: 41% (visits) to 325% (hospital days) across Maryland counties.
    • Patient characteristics explained up to 60% of variation; physician factors up to 17%; geographic area minimal.

    Conclusions:

    • Risk adjustment is essential due to the large proportion of variation explained by patient case mix.
    • Considerable variation in resource use persists across provider types and regions, impacting healthcare service delivery efficiency.