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Physician Payment Incentives and Associated Healthcare Utilization Outcomes in Medicaid Enrolled Asthmatic Children

Author(s): J. Chang, Isha Patel1, R. Balkrishnan2 and W. S Suh3,*
Humana - Comprehensive Health Insights, Louisville, KY 40202, 1Department of Biopharmaceutical Sciences, Bernard J. Dunn School of Pharmacy, Shenandoah University, Winchester, VA 22601, 2Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottsville, VA 22908, USA, 3Department of Global Healthcare Management, Gachon University, Seongnam-si, Gyeonggi-do, Korea

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Humana - Comprehensive Health Insights, Louisville, KY 40202, USA E-mail:

Very few studies have captured the differences in the outcomes of Medicaid patients between fee-for-service and capitation plan. This study measures the impact of fee-for-service vs. capitation plan on the healthcare utilization and medication adherence in asthmatic children enrolled in Medicaid. A retrospective cohort study was utilized to analyze Medicaid data from 8 states. The data were comprised of medical records such as healthcare utilization, medication and eligibility records of 6435 Medicaid enrolled asthmatic children that had newly started pharmacotherapy for asthma. Quantile regression was used to study medication adherence and Poisson regression was used to determine healthcare utilization. Patients in fee-for-service plans were significantly associated with higher medication adherence rates (p<0.05). Compared to patients in fee-for-service plans, patients in capitation plans had 52% (p<0.05) more hospitalizations, 52% fewer outpatient visits and 32% (p<0.05) more emergency department visits. Medicaid programs primarily use capitation based managed care plans for keeping a check on the healthcare costs. Yet, these plans might not be that cost-effective for the long-term management of asthma. Hence, the policy makers and third party payers should consider disease specific needs of children in order to achieve improved access to care and medication for better management of a particular disease.

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