The Effect of HMOs on Emergency Room Expenditures Among Adult Asthma Patients Öffentlichkeit
van Den Broek, Eline Altenburg (2014)
Published
Abstract
Chronic diseases, such as asthma, make up the majority of rising health expenditures. Because this type of disease and associated costs respond to preventive care, this study examines whether enrollment in an HMO (associated with preventive care) predicts ER expenditures for asthma patients.
Using data from the 2009-2011 Medical Expenditure Panel Survey (MEPS), we employed a two part model to predict a) the probability of incurring any ER expenditures and b) conditional health expenditures in dollars among adult asthma patients who incurred any ER expenditures. We also looked at differences in predicted ER expenditures for enrollees of public and private insurance. All regressions were adjusted for demographics, public versus private insurance and perceived health status.
We found no significant effect of HMO enrollment on the probability of any ER expenses or conditional ER expenditure, but we did find that private plans had a 56% lower probability of any ER expenditures than public plans. In contrast, once in the ER, patients with private plans had substantial higher predicted expenditures than those in public. However, there was no interaction effect of private insurance and HMO status.
We found that asthma patients with a family income that is slightly above (between 100-125% of) the Federal Poverty Level are more than 4 times more likely to visit the ER. Demographics and perceived health status were also found to be significant predictors of ER usage and expenditures.
This study provides new insights for the discussion about the effect of insurance type on health care expenditures. If we enlarge our sample size, by including more years or by looking at a broader scope of chronic conditions, we may be able to get a more precise estimate of this relation.
Table of Contents
Table of Contents
1.
Introduction......................................................................................................................1
2. Literature
Review...............................................................................................................2
Asthma, Importance of Preventive Care in
Asthma..................................................................2
Importance of Preventive Care in Asthma
Patients.......................................................................3
Effect of Preventive Care on
Expenditures..................................................................................4
Effect of HMOs on Health Care
Expenditures...............................................................................5
Effect of HMO on Health Care Utilization for Asthma
Patients.........................................................6
Summary of Literature
Limitations.............................................................................................8
3.
Methods...........................................................................................................................9
Conceptual
Framework.................................................................................................9
Research Questions and
Hypothesis..........................................................................................11
Data
Source.........................................................................................................................11
Study Design and
Subjects......................................................................................................12
Data
Analysis........................................................................................................................14
4.
Results.............................................................................................................................20
Descriptive
Analysis................................................................................................................20
Regression
Analysis.................................................................................................................23
5.
Discussion.........................................................................................................................26
Summary of
Findings...............................................................................................................26
Protocols for Prevention and Benefit Structure: Using Georgia as an
Example.............................26
Study
Limitations....................................................................................................................30
Policy
Imlications........................................................
...........................................................32
Future
Study..........................................................................................................................34
6.
Conclusion..........................................................................................................................36
References.............................................................................................................................37
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