AHRQ Electronic Newsletter, Issue #353

Preventable Hospitalizations Decline Among Patients Covered by Medicare Managed Care

Preventable hospitalization rates for the patients enrolled in Medicare managed care plans declined significantly in Arizona, Massachusetts, and New York between 1995 and 2005, results of a new AHRQ-funded study show.   Using Healthcare Cost and Utilization Project (HCUP) hospital discharge data, the study found that enrollment in Medicare managed care plans increased substantially during this period; the decline in preventable hospitalization rates became weaker over time.  The purpose of the study was to determine the net result of Medicare changes enacted through the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 and their impact on beneficiaries’ access to quality primary care.  AHRQ researcher Jayasree Basu, Ph.D., said the findings are important in light of an accelerated enrollment in private fee-for-service managed care plans after 2003, and a growing debate on their performance.  The study, “Preventable Hospitalizations and Medicare Managed Care: A Small Area Analysis,” was published in the August 20 issue of The American Journal of Managed Care.  A reprint copy is available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.