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Association Between Managed Care Enrollments and Potentially Preventable Hospitalization Among Adult Medicaid Recipients in Florida
Title
The Association Between Managed Care Enrollments and Potentially Preventable Hospitalization Among Adult Medicaid Recipients in Florida.
Creator
Lee, Keon-Hyung, Park, Jungwon
Abstract/Description
Background The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the...
Show moreBackground The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations. Methods The study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care. Results The results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant. Conclusions The results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients.
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Date Issued
2014-06-10
Identifier
FSU_libsubv1_scholarship_submission_1474987085, 10.1186/1472-6963-14-247
Format
Citation
Closure of a local public hospital in Korea
Title
Closure of a local public hospital in Korea: focusing on the organizational life cycle..
Creator
Yeo, Young Hyun, Lee, Keon-Hyung, Kim, Hye Jeong
Abstract/Description
Just as living organisms have a creation-maintenance-extinction life cycle, organizations also have a life cycle. Private organizations will not survive if they fail to acquire necessary resources through market competition. Public organizations, however, continue to survive because the government has provided financial support in order to enhance public interest. Only a few public organizations in Korea have closed. With the introduction of new public management since the economic crisis in...
Show moreJust as living organisms have a creation-maintenance-extinction life cycle, organizations also have a life cycle. Private organizations will not survive if they fail to acquire necessary resources through market competition. Public organizations, however, continue to survive because the government has provided financial support in order to enhance public interest. Only a few public organizations in Korea have closed. With the introduction of new public management since the economic crisis in 1997, however, public organizations have had to compete with private organizations. Public hospitals are not free to open or close their business. They are also controlled by the government in terms of their prices, management, budgets, and operations. As they pursue public interest by fulfilling the government's order such as providing free or lower-priced care to the vulnerable population, they tend to provide a lower quality of care and suffer a financial burden. Employing a case study analysis, this study attempts to understand the external environment that local public hospitals face. The fundamental problem of local public hospitals in Korea is the value conflict between public interest and profitability. Local public hospitals are required to pursue public interest by assignment of a public mission including building a medical safety net for low-income patients and managing nonprofitable medical facilities and emergent health care situations. At the same time, they are required to pursue profitability by achieving high-quality care through competition and the operation of an independent, self-supporting system according to private business logic. Under such paradoxical situations, a political decision may cause an unexpected result.
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Date Issued
2016-11-11
Identifier
FSU_pmch_29355194, 10.2147/JHL.S113070, PMC5741012, 29355194, 29355194, jhl-8-095
Format
Citation
emergence and effectiveness of global health networks
Title
The emergence and effectiveness of global health networks: findings and future research..
Creator
Shiffman, Jeremy, Schmitz, Hans Peter, Berlan, David, Smith, Stephanie L, Quissell, Kathryn, Gneiting, Uwe, Pelletier, David
Abstract/Description
Global health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority,...
Show moreGlobal health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority, they do matter, particularly for shaping the way the problem and solutions are understood, and convincing governments, international organizations and other global actors to address the issue. Their national-level effects vary by issue and are more difficult to ascertain. Networks are most likely to produce effects when (1) their members construct a compelling framing of the issue, one that includes a shared understanding of the problem, a consensus on solutions and convincing reasons to act and (2) they build a political coalition that includes individuals and organizations beyond their traditional base in the health sector, a task that demands engagement in the politics of the issue, not just its technical aspects. Maintaining a focused frame and sustaining a broad coalition are often in tension: effective networks find ways to balance the two challenges. The emergence and effectiveness of a network are shaped both by its members' decisions and by contextual factors, including historical influences (e.g. prior failed attempts to address the problem), features of the policy environment (e.g. global development goals) and characteristics of the issue the network addresses (e.g. its mortality burden). Their proliferation raises the issue of their legitimacy. Reasons to consider them legitimate include their members' expertise and the attention they bring to neglected issues. Reasons to question their legitimacy include their largely elite composition and the fragmentation they bring to global health governance.
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Date Issued
2016-04-01
Identifier
FSU_pmch_27067141, 10.1093/heapol/czw012, PMC4954561, 27067141, 27067141, czw012
Format
Citation
Expelled uninsured patients in a less-competitive hospital market in Florida, USA
Title
Expelled Uninsured Patients In A Less-competitive Hospital Market In Florida, Usa.
Creator
Lee, Keon-Hyung, Lim, Seunghoo, Park, Jungwon
Abstract/Description
Background: This research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. Methods: By developing the payer-specific level of...
Show moreBackground: This research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. Methods: By developing the payer-specific level of hospital competition, this research evaluates the effect of hospital competition on inward and outward patient sharing (or patient transfers) for different types of payers including the uninsured. For patient transfers, instead of focusing on whether a patient is transferred from one hospital to another hospital at the patient level, we measure the numbers of patient transfers between hospitals (both inward and outward) at the hospital level. These dependent variables-the numbers of outward and inward patient transfers by the principal payers-are count variables, and we employ either a Poisson regression model or a negative binomial regression model. Results: Controlling for hospital characteristics, when the uninsured Hirschman-Herfindahl Index (HHI) increased by 0.01, the uninsured were 593 % more likely to be transferred to another hospital. When a hospital dominates its market, it tends to expel uninsured patients to other hospitals. Conclusion: If patient transfers are medically unnecessary and primarily due to financial incentives, health administrators and policymakers should minimize such events. Since the uninsured who are admitted to a hospital that dominates its hospital market are likely to be much more vulnerable in their access to health care services, the state government of Florida needs to move toward increased health insurance coverage for eligible Floridians.
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Date Issued
2016-06-04
Identifier
FSU_libsubv1_wos_000377572500002, 10.1186/s12939-016-0375-z
Format
Citation
Expelled Uninsured Patients in a Less-Competitive Hospital Market in Florida, USA
Title
Expelled Uninsured Patients in a Less-Competitive Hospital Market in Florida, USA.
Creator
Lee, Keon-Hyung, Lim, Seunghoo, Park, Jungwon
Abstract/Description
Background This research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. Methods By developing the payer-specific level of...
Show moreBackground This research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. Methods By developing the payer-specific level of hospital competition, this research evaluates the effect of hospital competition on inward and outward patient sharing (or patient transfers) for different types of payers including the uninsured. For patient transfers, instead of focusing on whether a patient is transferred from one hospital to another hospital at the patient level, we measure the numbers of patient transfers between hospitals (both inward and outward) at the hospital level. These dependent variables—the numbers of outward and inward patient transfers by the principal payers—are count variables, and we employ either a Poisson regression model or a negative binomial regression model. Results Controlling for hospital characteristics, when the uninsured Hirschman-Herfindahl Index (HHI) increased by 0.01, the uninsured were 593 % more likely to be transferred to another hospital. When a hospital dominates its market, it tends to expel uninsured patients to other hospitals. Conclusion If patient transfers are medically unnecessary and primarily due to financial incentives, health administrators and policymakers should minimize such events. Since the uninsured who are admitted to a hospital that dominates its hospital market are likely to be much more vulnerable in their access to health care services, the state government of Florida needs to move toward increased health insurance coverage for eligible Floridians.
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Date Issued
2016-06-04
Identifier
FSU_libsubv1_scholarship_submission_1475607662, 10.1186/s12939-016-0375-z
Format
Citation
Expelled uninsured patients in a less-competitive hospital market in Florida, USA.
Title
Expelled uninsured patients in a less-competitive hospital market in Florida, USA.
Creator
Lee, Keon-Hyung, Lim, Seunghoo, Park, Jungwon
Abstract/Description
This research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. By developing the payer-specific level of hospital competition...
Show moreThis research evaluates the effect of hospital competition on inward and outward patient transfers for different types of payers including the uninsured. Although it is a less spotlighted issue, an equally important topic is the likelihood of inter-hospital patient transfers of the insured and the uninsured. This study attempts to fill a gap in the research about the relationship between hospital competition and patient transfers. By developing the payer-specific level of hospital competition, this research evaluates the effect of hospital competition on inward and outward patient sharing (or patient transfers) for different types of payers including the uninsured. For patient transfers, instead of focusing on whether a patient is transferred from one hospital to another hospital at the patient level, we measure the numbers of patient transfers between hospitals (both inward and outward) at the hospital level. These dependent variables-the numbers of outward and inward patient transfers by the principal payers-are count variables, and we employ either a Poisson regression model or a negative binomial regression model. Controlling for hospital characteristics, when the uninsured Hirschman-Herfindahl Index (HHI) increased by 0.01, the uninsured were 593 % more likely to be transferred to another hospital. When a hospital dominates its market, it tends to expel uninsured patients to other hospitals. If patient transfers are medically unnecessary and primarily due to financial incentives, health administrators and policymakers should minimize such events. Since the uninsured who are admitted to a hospital that dominates its hospital market are likely to be much more vulnerable in their access to health care services, the state government of Florida needs to move toward increased health insurance coverage for eligible Floridians.
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Date Issued
2016-06-04
Identifier
FSU_pmch_27262483, 10.1186/s12939-016-0375-z, PMC4893265, 27262483, 27262483, 10.1186/s12939-016-0375-z
Format
Citation
framework on the emergence and effectiveness of global health networks.
Title
A framework on the emergence and effectiveness of global health networks.
Creator
Shiffman, Jeremy, Quissell, Kathryn, Schmitz, Hans Peter, Pelletier, David L, Smith, Stephanie L, Berlan, David, Gneiting, Uwe, Van Slyke, David, Mergel, Ines, Rodriguez,...
Show moreShiffman, Jeremy, Quissell, Kathryn, Schmitz, Hans Peter, Pelletier, David L, Smith, Stephanie L, Berlan, David, Gneiting, Uwe, Van Slyke, David, Mergel, Ines, Rodriguez, Mariela, Walt, Gill
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Abstract/Description
Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on...
Show moreSince 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality and newborn deaths. This article presents a conceptual framework delineating factors that may shape why networks crystallize more easily surrounding some issues than others, and once formed, why some are better able than others to shape policy and public health outcomes. All supplement papers draw on this framework. The framework consists of 10 factors in three categories: (1) features of the networks and actors that comprise them, including leadership, governance arrangements, network composition and framing strategies; (2) conditions in the global policy environment, including potential allies and opponents, funding availability and global expectations concerning which issues should be prioritized; (3) and characteristics of the issue, including severity, tractability and affected groups. The article also explains the design of the project, which is grounded in comparison of networks surrounding three matched issues: TB and pneumonia, tobacco use and alcohol harm, and maternal and newborn survival. Despite similar burden and issue characteristics, there has been considerably greater policy traction for the first in each pair. The supplement articles aim to explain the role of networks in shaping these differences, and collectively represent the first comparative effort to understand the emergence and effectiveness of global health networks.
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Date Issued
2016-04-01
Identifier
FSU_pmch_26318679, 10.1093/heapol/czu046, PMC4954553, 26318679, 26318679, czu046
Format
Citation
Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida
Title
Length of Stay and Inpatient Costs Under Medicaid Managed Care in Florida.
Creator
Park, Jungwon
Abstract/Description
This study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care...
Show moreThis study examines the patterns of length of stay (LOS) and inpatient costs for both Medicaid managed care and nonmanaged care patients using data from Medicaid patients aged 18 to 64 years who were discharged from hospitals in Florida between 2006 and 2012. This study used pooled cross-sectional multilevel modeling. The results show that the type of Medicaid program in which patients were enrolled was significantly related to the hospital LOS and inpatient costs. Medicaid managed care patients had 7% shorter LOSs and a 1.9% lower inpatient cost than did Medicaid fee-for-service (FFS) patients. Medicaid managed care patients had shorter LOSs in the Medicaid managed care market with high competition. High managed care penetration generates a cost-decreasing spillover to Medicaid FFS patients.
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Date Issued
2015-10-14
Identifier
FSU_libsubv1_scholarship_submission_1475607311, 10.1177/0046958015610762
Format
Citation
Pneumonia's second wind? A case study of the global health network for childhood pneumonia.
Title
Pneumonia's second wind? A case study of the global health network for childhood pneumonia.
Creator
Berlan, David
Abstract/Description
Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues....
Show moreAdvocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.
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Date Issued
2016-04-01
Identifier
FSU_pmch_26438780, 10.1093/heapol/czv070, PMC4954558, 26438780, 26438780, czv070
Format
Citation
Why Is China's Wind Power Generation Not Living Up To Its Potential?
Title
Why Is China's Wind Power Generation Not Living Up To Its Potential?.
Creator
Huenteler, Joern, Tang, Tian, Chan, Gabriel, Anadon, Laura Diaz
Abstract/Description
Following a decade of unprecedented investment, China now has the world's largest installed base of wind power capacity. Yet, despite siting most wind farms in the wind-rich Northern and Western provinces, electricity generation from Chinese wind farms has not reached the performance benchmarks of the United States and many other advanced economies. This has resulted in lower environmental, economic, and health benefits than anticipated. We develop a framework to explain the performance of...
Show moreFollowing a decade of unprecedented investment, China now has the world's largest installed base of wind power capacity. Yet, despite siting most wind farms in the wind-rich Northern and Western provinces, electricity generation from Chinese wind farms has not reached the performance benchmarks of the United States and many other advanced economies. This has resulted in lower environmental, economic, and health benefits than anticipated. We develop a framework to explain the performance of the Chinese and US wind sectors, accounting for a comprehensive set of driving factors. We apply this framework to a novel dataset of virtually all wind farms installed in China and the United States through the end of 2013. We first estimate the wind sector's technical potential using a methodology that produces consistent estimates for both countries. We compare this potential to actual performance and find that Chinese wind farms generated electricity at 37%-45% of their annual technical potential during 2006-2013 compared to 54%-61% in the United States. Our findings underscore that the larger gap between actual performance and technical potential in China compared to the United States is significantly driven by delays in grid connection (14% of the gap) and curtailment due to constraints in grid management (10% of the gap), two challenges of China's wind power expansion covered extensively in the literature. However, our findings show that China's underperformance is also driven by suboptimal turbine model selection (31% of the gap), wind farm siting (23% of the gap), and turbine hub heights (6% of the gap)-factors that have received less attention in the literature and, crucially, are locked-in for the lifetime of wind farms. This suggests that besides addressing grid connection delays and curtailment, China will also need policy measures to address turbine siting and technology choices to achieve its national goals and increase utilization up to US levels.
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Date Issued
2018-04
Identifier
FSU_libsubv1_wos_000427927500001, 10.1088/1748-9326/aaadeb
Format
Citation