The Balanced Budget Act of 1997 introduced the new payment methodology for Medicare managed care plans. However, many managed care organizations started to withdraw from the Medicare market after the implementation of the Act, adversely affecting the accessibility to managed care plans for Medicare beneficiaries. The objective of the study is to examine the determinants of Medicare plus Choice Coordinated Care Plan withdrawal in the post-BBA era. Data on HMO plans for the years 1999 to 2002 were obtained from various sources for the pooled cross section and time series analyses. Samples were organized as per county, per contract, and per county-contract units. Several factors, including organizational attributes, geographic characteristics, performance measures, plan attributes, the degree of market competition, and time, were used for this study. Binomial logit model, multinomial logit model, and negative binomial regression model were employed for data analysis The results demonstrated that factors such as a higher level of M+C payment rate, higher out-of-pocket premiums, the provision of drug coverage, for-profit MCOs, contracts serving large amounts of counties, and a higher number of competitors in the service areas, would increase the probability of contract withdrawal. On the other hand, a higher number of M+C CCP enrollment, higher inpatient care capacity in counties, and more preventive care for enrollees offered by MCOs would reduce the probability of contract withdrawal. The selection effect of MCOs in choosing the service areas based on the demographic factors was detected. In addition, counties experiencing lower payment growth after the BBA tended to have lower numbers of M+C CCP contracts. Though contracts whose service areas had a smaller variance of payment growth after the BBA were found to be less likely to experience termination, they were more likely to experience partial withdrawal. This study advised policymakers to devise a more flexible reimbursement system, to develop a monitoring system to investigate weak contracts, and to develop policies for helping MCOs alleviate the problem of contract withdrawal while controlling the quantity and quality of care for beneficiaries / acase@tulane.edu
| Identifer | oai:union.ndltd.org:TULANE/oai:http://digitallibrary.tulane.edu/:tulane_25990 |
| Date | January 2005 |
| Contributors | Huang, Chun-Chih (Author), Khan, M. Mahmud (Thesis advisor) |
| Publisher | Tulane University |
| Source Sets | Tulane University |
| Language | English |
| Detected Language | English |
| Rights | Access requires a license to the Dissertations and Theses (ProQuest) database., Copyright is in accordance with U.S. Copyright law |
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