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Managed Care and the Diffusion of Endoscopy in Fee‐for‐Service Medicare
Author(s) -
Mobley Lee Rivers,
Subramanian Sujha,
Koschinsky Julia,
Frech H. E.,
Trantham Laurel Clayton,
Anselin Luc
Publication year - 2011
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2011.01301.x
Subject(s) - sigmoidoscopy , colonoscopy , managed care , medicine , socioeconomic status , fee for service , population , physician supply , health care , environmental health , economics , colorectal cancer , cancer , economic growth
Objective To determine whether M edicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee‐for‐service ( FFS ) M edicare population during 2001–2006. Methods We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county‐area utilization rates over two time intervals (2001–2003, 2004–2006) following M edicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross‐sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. Results Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS M edicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology.