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Health Care Costs and Financing

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Medicaid managed care programs decreased the likelihood of repeat c-sections during the 1990s

First-time or primary c-sections are hardly ever performed on an elective basis, whereas many repeat c-sections are, that is, there often are no clinical indications for the surgery. Fixed payments to managed care providers are designed to give them an incentive to reduce use of unnecessary services such as many repeat c-sections.

It is not surprising then that as more Ohio women became enrolled in Medicaid managed care programs (MCP) versus fee-for-service (FFS) programs from 1992 to 1997, the overall rate of repeat c-sections declined, while the rate of first-time c-sections remained about the same for both groups. Also, the difference between the rates of repeat c-sections between FFS and MCP groups diminished, with the rates converging over time, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00059).

In fact, the difference between the two groups in the likelihood of undergoing repeat c-section observed in 1992 was not present in 1997, despite the lack of utilization review efforts in the FFS group, says Case Western Reserve University researcher, Siran M. Koroukian, Ph.D. Dr. Koroukian and colleagues cite several possible explanations for the closing gap in repeat c-section rates between the two groups.

Expansion of Medicaid MCP markets probably resulted in a pooling of physician and hospital resources at the community level. Thus, most doctors who cared for Ohio Medicaid MCP enrollees also retained their FFS patients and probably exercised the same practice style in caring for all their patients regardless of the payment method. Also, more than two-thirds of Medicaid-eligible women were receiving care through Medicaid MCPs by the end of the study period, making it more difficult for managed care organizations to enroll lower risk patients. As a result, the MCP and FFS groups may have become more similar in their risk profiles over time.

The study findings are based on analysis of Ohio birth records and Medicaid files on women in urban Ohio counties who had single live births from 1992 through 1997. The researchers analyzed changes in primary and repeat c-section rates in the FFS and MCP groups.

See "Comparison of cesarean section rates in fee-for-service versus managed care patients in the Ohio Medicaid population, 1992-1997," by Dr. Koroukian, Donna Bush, M.S.W., and Alfred A. Rimm, Ph.D., in the February 2001 American Journal of Managed Care 7, pp. 134-142.

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