The Impact of Managed Care on Access to Highly Active Antiretroviral Therapy and on Outcomes among Medicaid Beneficiaries with AIDS
- 1 February 2007
- journal article
- research article
- Published by SAGE Publications in Medical Care Research and Review
- Vol. 64 (1) , 66-82
- https://doi.org/10.1177/1077558706296243
Abstract
Medicaid has promoted managed care plans (MCPs) to control health care costs for HIV-infected enrollees. This article examines the impact of MCP enrollment on use of highly active antiretroviral therapy (HAART), antiretroviral therapy (ARV), hospitalization, and death among Medicaid beneficiaries with AIDS. A retrospective longitudinal cohort study of 7,028 Medicaid beneficiaries with AIDS in California was conducted from 1999 to 2001. The impact of MCP enrollment was estimated using single-equation and bivariate probit models. Baseline HAART use was found to be significantly lower for beneficiaries in MCPs versus fee-for-service (FFS). The effect was attenuated and not significant after correcting for selection bias. MCP enrollment was not associated with overall ARV use, mortality, or hospitalization. MCP enrollment does not substantially affect medication use or clinical outcomes. Before making changes to care delivery, policy makers should address the potential costs and benefits of MCP over FFS Medicaid for chronically ill beneficiaries.Keywords
This publication has 17 references indexed in Scilit:
- Effective HIV Treatment and the Employment of HIV+ AdultsHealth Services Research, 2004
- Initiation and continuation of newer antiretroviral treatments among medicaid recipients with AIDSJournal of General Internal Medicine, 2001
- Expenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral TherapyNew England Journal of Medicine, 2001
- A Comprehensive Plan for Managed Care of Patients Infected with Human Immunodeficiency VirusClinical Infectious Diseases, 1999
- The Care of HIV-Infected Adults in the United StatesNew England Journal of Medicine, 1998
- Rolling Down the RunwayJAMA, 1998
- Using administratively collected hospital discharge data for AIDS surveillanceAnnals of Epidemiology, 1995
- Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality?JAMA, 1994
- A Severity Classification System for AIDS HospitalizationsMedical Care, 1989
- Bootstrap Methods for Standard Errors, Confidence Intervals, and Other Measures of Statistical AccuracyStatistical Science, 1986