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Clinical, Financial Woes Seen For Those Who Switch Plans

MANAGED CARE November 2003. © MediMedia USA
News and Commentary

Clinical, Financial Woes Seen For Those Who Switch Plans

MANAGED CARE November 2003. ©MediMedia USA

Patients who change health plans may face adverse clinical and financial effects as a result, according to a new study. Researchers at the University of California — Davis found that "the first year of insurance was associated with a higher risk of not get-ting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing."

The study, published in the September/October issue of the Annals of Family Medicine, says that 20 percent of consumers switch health plans each year. The frequency with which enrollees switch has long been cited as a possible reason that there is not more investment in disease management. Patients who benefit from one insurer's disease management program may jump to a different company in a few years.

This study — "On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan" — suggests that such mobility is not good for consumers either. The data, from an IPA in Rochester, N.Y., involved 335,547 adults from 1996 through 1999.

Exactly why costs increase is difficult to pin down.

The authors state: "The higher adjusted expenditures in newly insured patients might reflect either decreased efficiency of care delivery or appropriate catch-up in care, especially for those without previous health insurance.

"Because we could not distinguish between persons switching health plans and those not previously insured, we were unable to develop a reliable algorithm for the claims data that would allow distinction between these two possibilities."

They note other studies showing that patients' satisfaction drops when they are forced to go hunting for another insurer.

Employers may get less than they bargain for in the insurance rebidding process.

"Given the relative stability of the health care insurance market in Rochester, it is likely that these findings ... underestimate ... effects in more competitive insurance environments with more frequent insurance changes."