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Managed Care

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Increased HMO market penetration and local access to primary care doctors can reduce hospital admissions among children

Hospitalization of children for conditions such as asthma, hypoglycemia, epilepsy, and dehydration—so-called ambulatory-care-sensitive (ACS) conditions—often can be prevented by good primary care. High rates of locally available primary care doctors and high market penetration by health maintenance organizations (HMOs) were associated with reduced children's hospitalizations for ACS conditions in New York in 1994, according to a study by Agency for Healthcare Research and Quality researchers, Bernard Friedman, Ph.D., and Jayasree Basu, Ph.D.

Drs. Friedman and Basu analyzed 1994 discharges of New York residents from hospitals in New York and three neighboring States using data from AHRQ's Healthcare Cost and Utilization Project (HCUP). In counties with a higher proportion of Medicaid and self-pay children, ACS hospitalization rates were significantly higher. In counties with a higher proportion of children with private HMO coverage, ACS hospitalization rates were significantly lower. This finding offers encouragement to States in contracting for Medicaid enrollment in managed care plans, note the researchers.

They point out that privately insured patients with HMO plans generally have only a small out-of-pocket cost for primary and preventive services, while other private insurance plans generally have better coverage for hospital-based than office-based health services. Other factors also influenced ACS admission rates. For example, counties with more minority residents had higher ACS admission rates, independent of insurance, severity of illness, and distance. This may reflect, in part, income and environmental quality. Distance from hospitals was a significant deterrent to ACS admissions. The authors conclude that Medicaid contracting with HMOs, suitably monitored for undertreatment, and increasing the availability of primary and preventive services might substantially reduce ACS admissions.

For more details, see "Health insurance, primary care and preventable hospitalization of children in a large State," by Drs. Friedman and Basu, in the May 2001 Journal of Managed Care 7(5), pp. 473-481.

Reprints (AHRQ Publication No. 01-R074) are available from the AHRQ Publications Clearinghouse.

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