Medicaid managed care enrollments and potentially preventable admissions: An analysis of adult Medicaid recipients in Florida

ABSTRACT

This study examines the relationship between a managed care program and preventable hospitalization for Medicaid beneficiaries. Also, a theoretical framework of market competition is developed to examine the relationship between the Medicaid managed care market and preventable hospitalization for overall Medicaid patients across all Medicaid payer groups. The data of the study were 1,957,072 Medicaid patients aged 18–64 years who were discharged from a short-term general hospital in Florida from 2006 to 2012. We used two-level hierarchal models to predict the probability of preventable hospitalization. The results show that Medicaid managed care patients had a higher probability of preventable hospitalization than Medicaid fee-for-service patients. This study also found that market competition moderates the relationship between Medicaid insurance type and preventable hospitalization.

KEYWORDS:

• Preventable hospitalization
• primary care
• ambulatory care sensitive condition
• Medicaid managed care
• Medicaid

Disclosure statement

No potential conflict of interest was reported by the author.

Data availability statement

The data that support the findings of this study are available from the Agency for Health Care Administration (AHCA) Restrictions apply to the availability of these data, which were used under license for this study. Data are available at https://www.floridahealthfinder.gov with the permission of AHCA.

Additional information

Funding

This work was supported by a Research Grant of Andong National University.

Notes on contributors

Jungwon Park

Jungwon Park is an Assistant Professor of Public Administration in the College of Social Science at Andong National University, Korea. His work focuses on access to health services, the impact of hospital competition on hospital costs, and healthcare regulations. He has actively published his work in both public administration and health service administration journals including Public Performance & Management Review, International Review of Public Administration, INQUIRY, BMC Health Services Research, and International Journal for Equity in Health.