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An Evaluation of Utah's Primary Care Case Management Program for Medicaid Recipients

 

作者: Stephen Long,   Russell Settle,  

 

期刊: Medical Care  (OVID Available online 1988)
卷期: Volume 26, issue 11  

页码: 1021-1032

 

ISSN:0025-7079

 

年代: 1988

 

出版商: OVID

 

关键词: primary care case management;gatekeeper programs;Utah;Medicaid;freedom-of-choice;access to health care;cost containment

 

数据来源: OVID

 

摘要:

One of the first case management (CM) programs for limiting Medicaid enrollees' freedom of choice of provider was established by Utah. By assigning enrollees to specific providers responsible for arranging all nonemergency care, Utah intended both to improve access and to reduce program costs. State officials expected the program to increase recipients' use of primary-care providers, while reducing their use of specialists, prescription drugs, and hospital outpatient services. Savings from reductions in unnecessary use were expected to more than offset increases in outlays arising from access enhancements, resulting in lower program expenditures. This study investigated the extent to which the state Medicaid program achieved these goals. The analysis was based on a two-part multivariate model of usage, estimated from data created from claims-level information provided by Utah. The findings revealed that the use of primary-care physician services increased significantly. However, the program also raised the use of specialists' services and prescription drugs. In contrast, the use of hospital outpatient services was lowered. Overall, CM apparently achieved the objective of increased access, but failed to attain the cost-containment goal. The findings indicated that expected costs for ambulatory care rose by 25% in the early years as a result of case management.

 

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